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Retro-peritoneoscopy: anatomical rationale for direct retroperitoneal access
C C Capelouto1, R G Moore, S G Silverman
1Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, Maryland 21224.
The Journal of Urology
|December 1, 1994
Summary
Direct retroperitoneoscopy offers a safe and reliable approach to the upper urinary tract. This extraperitoneal technique minimizes risks associated with traditional transperitoneal surgery by utilizing the retroperitoneal space.
Area of Science:
- Urology
- Surgical Anatomy
- Minimally Invasive Surgery
Background:
- Traditional laparoscopic surgery for the upper urinary tract is transperitoneal.
- Transperitoneal approaches carry inherent risks.
- An extraperitoneal location of the upper urinary tract suggests alternative surgical access.
Purpose of the Study:
- To define the anatomical location of the retroperitoneum relative to surface anatomy.
- To develop and evaluate a direct retroperitoneal laparoscopic approach for upper urinary tract surgery.
Main Methods:
- Autopsy and radiographic studies were conducted to map the retroperitoneum.
- Patient positioning (lateral decubitus) was analyzed for its effect on retroperitoneal space.
- A novel direct retroperitoneoscopy technique was developed and implemented.
Main Results:
- The peritoneal reflection was consistently found anterior to the posterior axillary line.
- Lateral patient positioning doubled the anteroposterior extent of the retroperitoneal space.
- Direct retro-peritoneoscopy was successfully performed in 21 out of 23 patients.
Conclusions:
- Direct access to the retroperitoneum is anatomically feasible.
- The developed technique for direct retro-peritoneoscopy is safe and reliable.
- This approach offers a viable alternative to transperitoneal surgery for upper urinary tract procedures.