Reproperitoneoscopic surgery is minimal access surgical endoscopic inspection of the retroperitoneal structures is termed as retroperitoneoscopy. Earlier attempts at retroperitoneal surgery were largely unsuccessful due to inability to create and maintain an adequate working space thus favouring a transperitoneal approach. Undoubtedly, access to retroperitoneum and creation of a working space are the keys to success in retroperitoneal surgery. At World Laparoscopy Hospital , we have devised few new technique of retroperitoneoscopy which is simple, easily learned and requires no special materials. Initial space for introduction of primary trocar with sleeve is created using our indigenous balloon trocar technique followed by introduction of secondary ports under vision.
Retroperitoneoscopy was first described by Bartel in 1969, but is considered to be technically complicated because of the limited working space, lack of clear anatomical reference points, rich retroperitoneal fat. However, retroperitoneal anatomy is most familiar with the urologist because of retroperitoneal open surgery is often performed.
And the benefits do not come into the peritoneal cavity, such as the rapid return of bowel activity, preventing contamination of the peritoneal cavity with urine, urologists have to consider that possibility once again. Wickham reported ureterolithotomy retroperitoneoscopic starting in 1979. In 1982, Schultz Bay-Nielson and retroperitoneal endoscopy to remove the upper ureter stones. Retroperitoneaendoscopic nephrectomy first attempts were made by Coptcoat Wickham and Miller and Smith and Weinberg in early 1980, and is based on the technique of percutaneous kidney stone surgery. First transperitoneal laparoscopic nephrectomy was performed by Clayman et al. 1991.
Surgical details of this procedure.
The procedure is performed under general anesthesia under the supervision of CO2 at the end of the tide under the auspices of prophylactic antibiotics. After bladder catheterization, the patient is placed in a standard position of the right kidney. The surgeon and camera person on the right side of the patient, while piling sister was on the left side of the patient.
Technique for initial access. 10-12mm incision is made in the lumbar triangle (Petit) below the ribs 12 and the side edge paraspinalis muscle. Muscle fibers are carefully separated and entered the retroperitoneal perforation of thoracolumbar belt gently tipped hemostat. The balloon dilator is constructed as described by Gaur. It consists of a situation imposed silk gloves at the end of the suction catheter finger. Then the balloon dilator inserted into the opening. Air balloon distention and fast moving non-traumatic fat and neighboring peritoneum, creating enough space for retroperitoneal surgery in this area. Then the hole is 10 mm is placed in the opening and serves as a port. All works are visualized head of the table for tracking the use of a pair of devices for charging high quality (CCD) connected to laparoscopy. Luke 2:03 are inserted under direct vision, as shown Insulation automatically creator is used to maintain the pressure of 14mm Hg CO2. Psoas muscle acts as a reference point, and soon he was asked to enter the laparoscope.
Renal artery back kidney is reached and pulsating first identified in the hilum. Renal hilum is dissected, renal vein and renal artery without the fat and cut by League Division 400 ™ clips (Ethicon). Endo GIA clips, if necessary, can also be used. The three extracts were applied to the proximal end of the container and two at the distal end. The vessels are further divided and broken down kidney that separates it from the surrounding made fat. Ureter cuts and splits, and after the kidney was mobilized body completely eliminated by cutting one of the port sites and increased 2.5-3 cm. Drain remains in retroperitoneal and CO2 released before the end of the process. Collection bags Endo, where appropriate, also be used. The duration of the procedure was 145 minutes. In the first postoperative day, Foley catheter is withdrawn and oral feeding began after con fi rming the return of bowel sounds. The patient is fully mobilized within 24 hours after being removed flow. Stitches are kept dry and the patient was discharged on the third postoperative day. Monitoring, Pathohistologically revealed chronic pyelonephritis, but the patient was well and without complaint.
In recent years, laparoscopy has a great interest in the field of urology. He went from simple to complex diagnostic maneuvers operating procedures. Generally, anatomically speaking, retroperitoneoscopy seems to be more appropriate than a transperitoneal laparoscopic approach to get to the upper urinary tract. It is also less invasive and meets the criteria for open renal surgery. Endoscopic retroperitoneal nephrectomy first attempts were made by Wickham and Miller at the beginning of 1980, and are based on the technique of percutaneous kidney stone surgery. The real breakthrough is transperitoneal laparoscopic nephrectomy by Clayman et al. Access in 1991. Initially, endoscopic retroperitoneal upper and lower not found wide acceptance. The main reason was below optimal vision due to the inability to establish a pneumoperitoneum.
In addition, the creation of pneumoperitoneum with CO2 isolation of only that was the problem. The balloon dissection technique described by Gaur allowed safe and reproducible formation of retroperitoneal surgery on the ground. Rassweiler using simple shapes dissection showed that he was a patient for adequate exposure of the retroperitoneal space and reduces the operating time of 10-15 minutes.
The surgical technique of laparoscopic nephrectomy base described in detail and therefore Gill Clayman. The technique described here has not changed compared to the original description. Preoperative angiography or immobilization of renal artery was not executed because it increases the cost and morbidity and reference recently in the result. Some technical aspects need to be detailed in order to avoid complications and special attention to basic principles of surgery; under direct vision trocar placement; precise attention to prevent bleeding, the blood is still lower than in the field of view substantially darkened; access to renal hilum before or perirenal urethral dissection, if possible; the rear dissecting the anteromedial surface of the kidney in order to prevent a drop in the posteriorlateral stalks; The exposure and proper withdrawal; at the beginning of conversional operation to open in case of failure in progress. Complications in the category reteroperitonescopy inadvertently entering the peritoneal cavity; difficult to identify small renal atrophy; inadvertently bowel injury; excessive slip renal pedicle bleeding or trocar site; surgical emphysema and sepsis management kidney with hydronephrosis infected.
Conversion to open surgery may be needed to manage these complications. Except as laparoscopy diathesis and heart failure, bleeding or severe chronic obstructive pulmonary disease, retroperitoneal surgery standard history counter is a counter-indication for the procedure. The relatively lengthy procedure reported by some researchers for laparoscopic nephrectomy and nephroureterectomy has been used by critics who argue against the widespread adoption of this technology. Current period compared favorably to 145 minutes and 154 minutes reported in other series and modern open surgical series. Maintenance of continuous operation in accordance with open surgery, we support global star reported laparoscopic nephrectomy cheaper than open nephrectomy.
Conclusion is that the retroperitoneal nephrectomy is feasible, safe and minimally invasive techniques. The length of hospital stay and recovery time is short and return to normal activities quickly.