Bowel Retraction Research Articles

Comparison of laparoscopic and retroperitoneoscopic approaches to the great vessels in a porcine model

SummaryConventional laparoscopy has not yet been widely adopted for procedures involving the retroperitoneal organs, due to the problems of adequate bowel retraction and the poor access afforded by the position of the root of the mesentery. Developments in retroperitoneal laparoscopy facilitated by balloon dissection have afforded a new minimally invasive approach to the retroperito-neum. We have compared retroperitoneoscopic and laparoscopic approaches to the great vessels in a porcine model.

Extraperitoneal laparoscopic paraaortic lymph node dissection: development of a technique.

Surgical assessment of cervical cancer spread primarily involves pathologic evaluation of the pelvic and paraaortic lymph nodes. Extended field radiation therapy, which may result in a survival advantage, is often based on such surgical findings, since clinical staging is inaccurate for this purpose. Extraperitoneal lymph node dissection is superior to a transperitoneal laparotomy approach, largely because of the absence of intraperitoneal adhesion formation and resulting bowel complications. Although transperitoneal laparoscopy may reduce adhesion formation when compared with laparotomy, it does not eliminate this problem. We developed an entirely extraperitoneal laparoscopic technique for paraaortic lymph node dissection in a pig model, using latex balloon dissection technology. The technique was quick, had a short learning curve, and eliminated bowel retraction or dissection. Excellent bilateral retroperitoneal exposure was achieved from the level of the renal to the iliac vessels for aortocaval lymph node dissection.