Laparoscopic Nephrectomy: Retroperitoneal Approach

Laparoscopic nephrectomy was originally described using a transperitoneal approach. However, detractors have argued that the transperitoneal approach provides a less direct approach to retroperitoneal structures, risks injury to intraperitoneal viscera, and results in a longer postoperative ileus. With the development of a variety of dissecting balloons, retroperitoneal laparoscopic nephrectomy has been demonstrated to be safe and efficacious; in particular, small, benign kidneys may be best suited to the retroperitoneal approach. A variety of centers have reported excellent results using this approach.