Pure Retroperitoneal Optical Access Trocar for Lumbar Diseases in Adults: A Step-by-Step Technique

The primary end point of this study was to describe step by step the technique of the pure retroperitoneal optical access trocar (PROAT) in adults. The secondary end point was to access between-group differences in perioperative outcomes.

Forty-five patients underwent retroperitoneoscopic surgery using the PROAT technique to enter the retroperitoneal space (PROAT group). Thirty-nine patients underwent retroperitoneoscopic surgery using the conventional open-Hasson technique with manufactured Hasson-trocar and space-maker balloon to enter and create the retroperitoneal space (conventional group). PROAT technique was described. Data were prospectively collected and analyzed.

Mean time for first-entry trocar insertion was lower in the PROAT group (9.76±3.17 vs. 23±7.2 s; P<0.001). Mean time to develop the retroperitoneal space until all-trocar placement was higher in the PROAT group (12.7±3.3 vs. 6.4±2.2 min; P<0.001). Carbon dioxide gas leakage was not observed.

The PROAT technique is feasible and safe. This approach can potentially avoid carbon dioxide leakage when manufactured Hasson trocars are not available and allow a reduced-cost procedure.