Retroperitoneal Laparoscopy Research Articles

Diagnosis and treatment of adrenal cyst: report of 15 cases

To discuss the diagnosis and treatment of adrenal cyst. The clinical data of 15 patients with adrenal cyst, 9 males and 6 females, aged 42 (32 - 65), diagnosed and treated 1995 - 2005 were reviewed. The average size of the cyst was 5.3 cm in diameter. Nine cysts were in the left adrenal gland and 6 cysts in the right. The diagnostic accuracy rates of MR imaging, CT, and B-mode ultrasonography were 100% (4/4), 86.7% (13/15), and 73.3% (11/15) respectively. Thirteen patients underwent operation: unroofing in cyst via retroperitoneal laparoscopy (n = 9), adrenalectomy via laparoscopy (n = 1), or cystectomy via open surgery (n = 3). The average operative time of the 2 laparoscopy subgroups was (44 +/- 11) min, significantly shorter than that of the open surgery group [(75 +/- 40) min, P < 0.05]. The mean hospital stay after operation of the laparoscopy group was (5.1 +/- 1.1) days, significantly shorter than that of the open surgery group [(8.3 +/- 1.5) days, P < 0.05]. Pathological examination showed 3 cases of epithelial cyst,4 cases of endothelial cyst, and 6 cases of pseudocyst. MR is much more useful in diagnosis of adrenal cyst. The indications of surgery include the presence of symptoms, suspicion of malignancy, increase in the cyst size, and detection of functioning adrenal cyst. Unroofing in cyst via retroperitoneal laparoscopy may be the standard operation in treating this disease.

L’approche lomboscopique dans le traitement des calculs urétéraux lombaires

Retroperitoneal laparoscopy is a recent alternative to conventional surgical treatment of ureterolithiasis. The objective of this study was to evaluate the place of retroperitoneal laparoscopic ureterolithotomy. The authors report 50 cases of retroperitoneal laparoscopy for lumbar ureter stones performed in 49 patients between January 2001 and December 2006. The indications were a very large (>15 mm) obstructive stone in the lumbar ureter in 88% of cases, failure of extracorporeal shock wave lithotripsy (ESWL) in 6% of cases and refusal of ESWL in 6% of cases. The mean stone diameter was 17 mm (range: 10-35 mm). The stone was removed by retroperitoneal laparoscopy in 46 out of 50 cases (92%). The mean operating time was 97 min. (range: 35-170 min.). The surgical conversion rate was 8%. Ten patients (20%) developed a urinary fistula requiring secondary drainage by double J ureteric stent. The mean hospital stay was 6.8 days. No cases of ureteric stenosis or kidney destruction was observed with a mean follow-up of 32 months. Retroperitoneal laparoscopic lumbar ureterolithotomy is a safe, effective and minimally invasive technique which could constitute an alternative to open ureterolithotomy in the majority of its current indications.

Thoracic Complications of Urologic Laparoscopy: Correlation between Radiographic Findings and Clinical Manifestations

The usefulness of plain film chest radiography (CXR) in evaluation for thoracic complications after laparoscopic urologic procedures is uncertain. Our objectives were to examine the association between radiographic findings and clinical manifestations of thoracic complications after laparoscopic urologic procedures and to determine the prevalence of postoperative CXR at our institution. We performed a retrospective review of 195 patients who underwent laparoscopic renal/adrenal urologic procedures at our institution from 1998 to 2005. Chi-square analysis was used to compare the rate of radiographic abnormalities and thoracic complications between different types of laparoscopic procedures. A total of 96 patients (96/195, 49%) had postoperative CXR, and abnormalities were noted in 75 (75/96, 78%). The abnormalities seen on CXR included atelectasis, pleural effusions, pneumomediastinum, pneumothorax, subcutaneous emphysema, and pneumonia. Retroperitoneal laparoscopy had significantly more incidental subclinical pneumothoraces (P = 0.000469) and subcutaneous emphysema (P = 0.043) identified by CXR than either transperitoneal, hand-assisted, or cryosurgery. Overall, eight patients (8.3%) had clinical manifestations of a thoracic complication but only five (5.2%) were clinically significant complications detected by CXR. Thus, while 75 CXRs were noted as abnormal, 70 (93%) documented incidental findings that did not affect patient care. Thoracic complications after laparoscopic urologic procedures are uncommon events. Although the majority of CXRs after such procedures do contain abnormalities, most abnormalities are subclinical and do not affect postoperative management. Patients with significant radiographic findings demonstrated significant clinical symptoms. Thus, routine CXR after urologic laparoscopy does not appear to be necessary to identify thoracic complications and may be overused.

Diaphragmatic Repair and/or Reconstruction During Upper Abdominal Urological Laparoscopy

We present our experience with and the technique of laparoscopic mesh reconstruction or suture repair of intentional resection or intraoperative injury of the diaphragm. In a 10-year (1997 to 2006) review of 1,850 upper abdominal renal and/or adrenal laparoscopic procedures at our institution 13 patients (0.7%) sustained diaphragmatic entry, including iatrogenic injury in 7 (0.4%), deliberate laparoscopic excision of a portion of the diaphragm in 2 and diaphragmatic incision during transthoracic adrenalectomy in 4. Laparoscopic repair techniques involved primary suture repair in 11 cases and primary reconstruction with a synthetic graft in 2. A rubber catheter and water seal system were used to primarily evacuate the pneumothorax. Inadvertent diaphragmatic injury in 7 cases occurred during transperitoneal (6) and retroperitoneal (1) laparoscopy, including partial nephrectomy in 4, radical nephrectomy in 2 and adrenalectomy in 1. A diaphragmatic breach occurred due to hook electrocautery in 5 cases, trocar insertion in 1 and liver retraction in 1. Deliberate diaphragmatic excision and mesh reconstruction in 2 cases were performed after en bloc excision of the diaphragm during radical nephrectomy in 1 and during excision of a metastatic diaphragmatic nodule in 1. Four transthoracic transdiaphragmatic adrenalectomies were completed successfully without any intraoperative complications. All cases were completed laparoscopically without open conversion. A chest tube was placed prophylactically in the initial 2 patients undergoing transthoracic transdiaphragmatic adrenalectomy. Laparoscopic and transthoracic repair/reconstruction of the diaphragm is safe and effective.

Posterior approach for retroperitoneal laparoscopic bilateral native nephrectomy in prone position: Initial experience with four cases

Focal segmental glomerulosclerosis (FSGS) is known to recur in some patients after renal transplantation. Recently, laparoscopic nephrectomy has been introduced as a minimally invasive surgery. We present our experience with our first four patients with FSGS who underwent simultaneous bilateral native nephrectomy in the prone position by means of retroperitoneal laparoscopy before renal transplantation. This procedure provided adequate visualization and created enough working space for manipulation. The patients did not need to be repositioned. The mobilized specimens were removed through an incision extending from the first port or by means of morcellation within the sack. Mean operative time was 325 min and mean blood loss was 281 mL. The average time to resumption of oral intake was 1.3 days and all patients started ambulation on postoperative day 1. No major complications were observed. In conclusion, this procedure may become a useful option for native nephrectomy for FSGS patients before transplantation.

Comparison of Intraoperative Parameters and Perioperative Complications of Retroperitoneal and Transperitoneal Approaches to Laparoscopic Partial Nephrectomy: Support for a Retroperitoneal Approach in Selected Patients

Retroperitoneal laparoscopy (RP) may have some intrinsic advantages over transperitoneal laparoscopy (TP) in certain patients undergoing partial nephrectomy. We reviewed our experience with RP and TP partial nephrectomy to identify differences in intraoperative and postoperative parameters. The records of 72 patients (45 TP, 27 RP) undergoing laparoscopic partial nephrectomy without hand assistance between January 2003 and August 2005 were reviewed. The two groups were similar demographically; tumors were smaller in RP patients (2.1 v 2.7 cm; P = 0.03), and the RP approach was used more frequently on right kidneys (70.4% v 37.8%; P = 0.01). The operative time (mean 160 v 192 minutes; P = 0.008) and length of stay (LOS; median 1.0 days [range 1-10 days] v 2.0 days [range 1-64 days]; P = 0.001) were shorter in RP patients. Rates of collecting system entry (22% v 38%), positive-margin rate (0% v 6.7%; P = 0.29), and complications (19% v 22%; P = 0.77) were similar in RP and TP patients. Hemorrhage was the most common complication in both groups. Bowel-related complications occurred in three TP patients, but in no RP patients. Overall, the median estimated blood loss (EBL) was lower in RP patients (100 mL [range 25-3500 mL] v 225 mL [range 25-1900 mL]; P = 0.06). Among patients with complications, EBL was similar in both groups (median 325 mL [50-1500 mL] v 200 mL [50-3500 mL] for RP and TP; P = 0.86). The RP approach reduces operative time, LOS, and some types of complications without compromising the quality of tumor resection. Complications in the retroperitoneal space are not associated with higher EBL. Anatomic considerations and surgeon experience may improve outcomes.

Perinatal management of congenital cystic lung lesions in the age of minimally invasive surgery

Background Most congenital cystic lung lesions (CCLLs) do not require in utero or perinatal intervention. The management of asymptomatic lesions is controversial: the theoretical risk of infection and malignancy is offset by whether thoracotomy in asymptomatic children is justified. We examined our recent experience and the role of minimally invasive surgery. Methods We analyzed the pre-, peri-, and postnatal findings of all consecutive CCLLs diagnosed between 1997 and 2005. We reviewed records for pre-, and postnatal imaging, management, and outcome. Results Thirty-five CCLL were diagnosed prenatally. Since 2000, all asymptomatic lesions were removed endoscopically at 6 to 18 months (thoracoscopy for 6 extralobar sequestrations, 3 intralobar sequestrations/congenital cystic adenomatoid malformations, 5 bronchogenic cysts, and retroperitoneal laparoscopy for 2 intraabdominal sequestrations). Congenital cystic adenomatoid malformation elements were present in more than 70%. Two abdominal lesions have regressed, and 2 patients are awaiting intervention. One symptomatic infant underwent thoracotomy for congenital lobar emphysema. Conclusions It has been argued that the risks associated with congenital lung lesions (infection and malignancy) justify intervention in the asymptomatic patient. In our experience, all these lesions could be safely removed using endosurgical techniques. Counseling of (future) parents should be updated to include minimally invasive surgery in the management algorithm.

Laparoscopic Treatment for Renal Hydatid Cyst

A multivesicular hydatid cyst was removed from the left kidney of a 26-year-old woman by retroperitoneal laparoscopy to avoid contamination of the abdominal cavity. A scolicidal agent (20% hypertonic saline) was injected around the kidney initially and then instilled into the cyst after the contents had been evacuated. There were no complications and no anaphylactic shock. This appears to be the first reported case of treatment of renal hydatid cyst by laparoscopy.

Physiological effects of pediatric urological laparoscopic surgery

There is an increasing trend of laparoscopy in pediatric urological practice with more complex and reconstructive procedures being performed in smaller children. The physiological impact of these procedures is not well documented in the pediatric literature and cannot be simply extrapolated from the adult data. This article reviews the current pediatric literature on the physiological effects of both transperitoneal and retroperitoneal laparoscopy. The clinical implication of these changes and the need for proper monitoring is stressed. As surgeons strive to stretch the indications of laparoscopy in pediatric urological practice, the overall beneficial effects of laparoscopy must be balanced with these potential hemodynamic and respiratory changes.

PEDIATRIC RETROPERITONEAL LAPAROSCOPIC PARTIAL NEPHRECTOMY: COMPARISON WITH AN AGE MATCHED COHORT OF OPEN SURGERY

We assessed the clinical usefulness of laparoscopic retroperitoneal partial nephrectomy (LRPN) in children by comparing an age matched cohort of pediatric patients undergoing open partial nephrectomy (OPN) to those undergoing LRPN for safety, efficacy, operative time, blood loss, inpatient narcotic use and length of hospitalization. A retrospective case-control study was performed of 1 group undergoing LRPN (treatment arm) and 1 undergoing OPN (controls) between 1997 and 2003. The 14 patients in each group were matched by age (mean 1.9 years in LRPN group vs 2.2 years in OPN group, p = 0.98) and gender. All patients had duplication anomalies. Mean operative time was 194 minutes in the LRPN group and 193 minutes in the OPN group (p = 0.83). The single complication in the LRPN group was a urinoma that did not require intervention. There were no complications in OPN group. LRPN patients had a mean hospitalization of 1.7 days compared to 4.7 days in OPN patients (p = 0.001). Intraoperative narcotic requirements were higher in the LRPN group (0.59 vs 0.22 mg/kg, p = 0.04). Postoperative narcotic requirements were significantly less in the LRPN group (0.44 vs 1.53 mg/kg, p = 0.04). Similar findings were noted in a subanalysis of patients younger than 2 years. All patients had documented postoperative ipsilateral renal growth. Mean followups in the treatment and control groups were 26 and 25 months, respectively. Retroperitoneal laparoscopic partial nephrectomy in small children was shown to be safe and effective. It had equivalent operative times, and decreased postoperative narcotics and hospitalization relative to the open approach, and, therefore, is a potentially advantageous technique.

Hemodynamic effects of retroperitoneal laparoscopy in children

METHODS: With REB approval and written parental consent pediatric patients undergoing laparoscopic partial or total nephrectomy were enrolled. A standardized anesthetic technique of isoflurane 1 MAC and remifentanil 0.2 μg/kg/min was used. Parameters measured included peak airway pressure, end-tidal CO2, heart rate and mean arterial blood pressure. Data was collected before, during and after 12 mmHg of pneumoperitoneum, at regular 1-2 minute intervals. Within group analysis was performed using repeated measures ANOVA and values at different points of time were compared using paired t-test. P<0.05 was considered significant.

Cerebrovascular effects of retroperitoneal laparoscopy in children

METHODS: With REB approval and written parental consent pediatric patients undergoing laparoscopic partial or total nephrectomy were enrolled. A standardized anesthetic technique of isoflurane 1 MAC and remifentanil 0.2 μg/kg/min was used. Parameters measured included peak airway pressure, end-tidal CO2 and middle cerebral artery blood flow velocity (Vmca). Transcranial Doppler sonography was used to measure Vmca. Data was collected before, during and after 12 mmHg of retroperitoneal pneumoperitoneum, at regular 1-2 minute intervals. Within group analysis was performed using repeated measures ANOVA and values at different points of time were compared using paired t-test. P<0.05 was considered significant.

Retroperitoneal laparoscopic nephron-sparing surgery for renal tumors: Report of 32 cases

Objectives To evaluate the feasibility and clinical efficacy of retroperitoneal laparoscopic nephron-sparing surgery for renal tumors. Methods Between June 2002 and February 2004, 11 cases of renal benign tumor and 21 cases of renal malignant tumor underwent enucleation of the tumor and wedge resection of the tumor through retroperitoneal laparoscopy, respectively. Tumor resection and hemostasis were mainly achieved by harmonic scalpel. Follow-up studies were performed with an evaluation using renal spiral computed tomography. Results All procedures were technically successful. The mean operating time was 70 minutes for enucleation and 96 minutes for wedge resection. The mean estimated blood loss was 35 mL for enucleation and 65.5 mL for wedge resection. The mean hospital stay after surgery was 6.5 days. No intraoperative complications occurred. The pathologic examination confirmed renal cell carcinoma in 21 patients and angiomyolipoma in 11. The pathologic stage was pT1a in the 21 patients with renal cell carcinoma. All resected tumor specimens had negative surgical margins for cancer. No local recurrence or trocar site metastasis was observed during a mean follow-up period of 13 months. Conclusions Our results indicate that retroperitoneal laparoscopic nephron-sparing surgery represents a feasible option for patients with localized renal tumors. This procedure could offer precise and complete tumor excision while minimizing morbidity, improving cosmesis, and shortening convalescence.

1082: Retrospective Comparison of Transperitoneal Versus Retroperitoneal Laparoscopic Renal Cryoablation

You have accessJournal of UrologyModerated Poster, Tuesday, May 24, 2005, 8:00 - 10:00 am1 Apr 20051082: Retrospective Comparison of Transperitoneal Versus Retroperitoneal Laparoscopic Renal Cryoablation Patrick E. Davol, John F. Danella, Justin D. Harmon, and Daniel B. Rukstalis Patrick E. DavolPatrick E. Davol More articles by this author , John F. DanellaJohn F. Danella More articles by this author , Justin D. HarmonJustin D. Harmon More articles by this author , and Daniel B. RukstalisDaniel B. Rukstalis More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(18)35238-8AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "1082: Retrospective Comparison of Transperitoneal Versus Retroperitoneal Laparoscopic Renal Cryoablation." The Journal of Urology, 173(4S), pp. 293–294 © 2016 by American Urological AssociationFiguresReferencesRelatedDetails Volume 173Issue 4SApril 2005Page: 293-294 Advertisement Copyright & Permissions© 2016 by American Urological AssociationMetricsAuthor Information Patrick E. Davol More articles by this author John F. Danella More articles by this author Justin D. Harmon More articles by this author Daniel B. Rukstalis More articles by this author Expand All Advertisement PDF DownloadLoading ...

COMPLICATIONS OF LAPAROSCOPIC PARTIAL NEPHRECTOMY IN 200 CASES

We analyzed complications of the initial 200 cases treated with laparoscopic partial nephrectomy for a suspected renal tumor. Since August 1999, 200 consecutive patients have undergone laparoscopic partial nephrectomy. Mean patient age was 61.6 years, mean body mass index was 29.9 and mean tumor size was 2.9 cm (range 1 to 10). There were 51 central tumors (25%) and 15 solitary kidneys (7.5%). A central tumor was defined as any tumor infiltrating up to the collecting system or renal sinus, during the excision of which entry into and repair of the collecting system was necessary. Mean estimated blood loss was 247 cc and mean operative time was 3.3 hours. Data on complications were obtained from a prospectively maintained computerized database and via telephone calls to patients and/or local referring physicians. A total of 66 patients (33%) had 1 or more complications, which were intraoperative in 11 (5.5%), postoperative in 24 (12%) and delayed in 31 (15.5%). Overall 30 patients (15%) had a non-urological complication and 36 (18%) had a urological complication, including hemorrhage in 19 (9.5%) and urine leakage in 9 (4.5%). Hemorrhage occurred intraoperatively in 7 cases (3.5%) and postoperatively in 4 (2%), while it was delayed in 8 (4%). Of patients with urine leakage none required reoperation, 6 (3%) required a Double-J stent (Medical Engineering Corp., New York, New York) only, 2 (1%) required a Double-J stent with computerized tomography guided drainage and 1 required no treatment. Open conversion was necessary in 2 patients (1%), reoperation was done in 4 (2%) and elective laparoscopic radical nephrectomy was performed in 1 (0.5%). Laparoscopic partial nephrectomy is an advanced procedure with potential for complications. It requires considerable experience with reconstructive laparoscopy.

Retroperitoneal Laparoscopic Radical Nephrectomy for Renal Cell Carcinoma with Infrahepatic Vena Caval Thrombus

Purpose: The retroperitoneal laparoscopic approach is utilized to treat a right renal tumor with vena caval thrombus reaching infrahepatic veins. Materials and Methods: The patient is an 87-year-old woman with a tumor measuring 8 × 9 cm and a vena caval thrombus (7 cm), stretching as far as the subhepatic vein. The retroperitoneal laparoscopic approach is used with the patient in the lateral position and the usual 4 laparoscopy trocars. A wide incision is made through Gerota's fascia, the renal artery clipped and severed, and the vena cava is dissected to the level of the infrahepatic veins; a vessel loop is encircled twice upstream of the thrombus. Vessel loop is similarly tied below the thrombus. An 8 cm abdominal wall incision is made joining two trocars on the medial and anterior axillary side. After retrieving the vessel loops and closing the vena cava by pulling gently on the loops, thrombus is extracted through a cavotomy under direct vision, with removal of the surgical specimen, positioning of the Satinsky haemostatic forceps, and closure of the vena cava using uninterrupted Prolene 2/0 sutures. Results: Blood loss was 300 cc. The patient was discharged on day 6, and a CT-scan 4 months later disclosed no signs of recurrence. Conclusions: This is an original solution that opens the way to further indications for using retroperitoneal laparoscopy to treat tumors extending into the inferior vena cava.

THE HAND-ASSISTANCE ADVANTAGE OVER INTEGRAL RETROPERITONEOSCOPIC KIDNEY HARVESTING. THE INITIAL EXPERIENCE

A56 Aims: Hand assistance makes retroperitoneoscopic kidney harvesting a safe and effective procedure; a promise for a new standard. It gives a quick way in, a large working space, tactile discrimination and a quick way out for the harvested kidney. A proper hand assisted approach gives a clear-cut advantage for retroperitoneal laparoscopy. The aim of this study is to assess the hand assisted retroperitoneoscopic kidney harvesting. Methods: We assessed the initial results obtained with 10 hand-assisted retroperitoneoscopic kidney harvesting (HARH) compared with 25 standard retroperitoneoscopic procedures (RH). We have harvested only the left kidney. Vascular anomalies were accepted and corrected in bench surgery. The hand assistance is performed throw a 6 cm incision along the lateral side of the rectus abdominis muscle, beneath the umbilicus. A large working space is created by manual blunt dissection with subsequent extensive detachment of the peritoneum. The working trocar is placed at the tip of the XIIth rib and the telescope is placed above the iliac crest. Additional ports are placed as necessary. The dissection is easier and the kidney is immediately removed through hand assistance entrance. Results: All harvestings were successful. Mean operative time was shorter in HARH group (114.5 min. vs. 166.4 min). Cold ischemia time was minimal: 2.3 min. All grafts were functional after transplantation Conclusions: Hand assisted retroperitoneoscopic kidney harvesting promise to become the new standard in living donation.

THORACIC COMPLICATIONS DURING UROLOGICAL LAPAROSCOPY

We documented thoracic related complications during urological laparoscopic surgery. A total of 1129 patients underwent major urological laparoscopic procedures in a 5-year period. Operative reports and postoperative radiographic reports were retrospectively reviewed to identify patients with thoracic related medical and surgical sequelae. Of the patients 619 (55%) underwent at least 1 chest x-ray in the immediate or early postoperative period. In the remaining 510 patients (45%) there was no clinical indication to perform chest x-ray. Of 619 patients undergoing chest x-ray 438 (71%) were completely normal. Medical pulmonary complications, surgical thoracic complications and subclinical, incidentally detected gas collections in the chest were identified in 12.6%, 0.5% and 5.5% of patients, respectively. Medical complications in 12.6% of cases included pulmonary infiltrate/atelectasis in 9.7%, pleural effusion in 4.8% and pulmonary embolus in 0.3%. Surgical complications included symptomatic pneumothorax in 4 patients (0.35%), hemothorax in 1 (0.08%) and chylothorax in 1 (0.08%). Subclinical abnormal thoracic gas collections were radiographically noted in 34 of the 619 patients (5.5%) on chest x-ray, including pneumomediastinum in 19 (3.1%), pneumothorax in 10 (1.6%) and pneumopericardium in 5 (0.8%). Overall 36 of 40 (90%) thoracic surgical complications (3) and subclinical, incidentally detected gas collections (33) occurred during retroperitoneal laparoscopy. Re-intervention was necessary in 6 patients (0.5%), namely pulmonary embolus requiring vena caval filter placement in 3 (0.3%), pneumothorax requiring a chest tube in 2 (0.17%) and hemothorax requiring emergency open thoracotomy in 1 (0.08%). No patient underwent open conversion to complete the initial proposed operation. Due to its high solubility the expectant management of incidental CO2 pneumothorax, pneumopericardium and pneumomediastinum is recommended initially in the clinically stable patient. Inadvertent diaphragmatic entry can be satisfactorily repaired laparoscopically without open conversion. Although it is rare, surgical thoracic complications are potentially life threatening, requiring prompt identification and management.

572: Retroperitoneal Laparoscopic Versus Open Dismembered Pyeloplasty in Children

You have accessJournal of UrologyDiscussed Poster, Sunday, May 9, 2004, 1:00 - 5:00 pm1 Apr 2004572: Retroperitoneal Laparoscopic Versus Open Dismembered Pyeloplasty in Children Arnaud Bonnard, Yves Aigrain, and Alaa El-Ghoneimi Arnaud BonnardArnaud Bonnard More articles by this author , Yves AigrainYves Aigrain More articles by this author , and Alaa El-GhoneimiAlaa El-Ghoneimi More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(18)37834-0AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "572: Retroperitoneal Laparoscopic Versus Open Dismembered Pyeloplasty in Children." The Journal of Urology, 171(4S), p. 152 © 2016 by American Urological AssociationFiguresReferencesRelatedDetails Volume 171Issue 4SApril 2004Page: 152 Advertisement Copyright & Permissions© 2016 by American Urological AssociationMetricsAuthor Information Arnaud Bonnard More articles by this author Yves Aigrain More articles by this author Alaa El-Ghoneimi More articles by this author Expand All Advertisement PDF DownloadLoading ...

Justification of extraperitoneal laparoscopic access for surgery of the upper urinary tract.

Laparoscopic surgery was originally developed by gynecologists and general surgeons. Based on their experience, the first successful laparoscopic procedures in urology were performed transperitoneally. However, this novel technique transformed traditionally retroperitoneal procedures into transperitoneal procedures, giving free rein to distinct intraperitoneal complications. Retroperitoneal laparoscopy was a later development in urology. This approach has gained increasing popularity throughout the years and has challenged the transperitoneal laparoscopic route in many aspects. This review focuses on the advantages of retroperitoneal laparoscopic surgery of the upper urinary tract.