[Dorso-posterior extraperitoneal pelviscopy (DEP). From experiment to initial clinical application]

Area of Science:

• Minimally invasive surgery
• Pelvic anatomy
• Surgical endoscopy

Background:

• Traditional dorsoposterior and perineal approaches to pelvic connective tissue spaces have been superseded by advanced transabdominal techniques.
• The evolution of "soft-tissue endoscopy" prompted an investigation into reviving the perineal approach using video-assisted methods.
• Initial cadaver experiments paved the way for the first clinical application of this technique.

Observation:

• The study involved dilating retrorectal, rectovaginal, and rectoprostatic spaces using a dissecting balloon, establishing pneumoextraperitoneum for pelvic structure dissection.
• Both experimental and clinical applications demonstrated excellent visualization of pelvic spaces.
• Complete rectal preparation and visualization of ventral pelvic structures (bladder, vagina, prostate) and lateral structures (ureters, paraproctal and iliacal vessels) were achieved.

Findings:

• The retrorectal space was successfully dilated, rinsed, and drained in the clinical setting without complications.
• Experimental dissection allowed for comprehensive visualization and preparation of the rectum, bladder, vagina, prostate, ureters, and major pelvic vessels.
• The patient in the clinical trial experienced no postoperative complications and was discharged on the 17th postoperative day.

Implications:

• The video-assisted perineal approach is a viable and safe method for clinical use in pelvic surgery.
• This technique holds potential for various surgical applications beyond the initially described indication.
• Revitalization of the perineal approach through minimally invasive endoscopy offers new possibilities in pelvic surgery.