Videoendoscopic surgery by extraperitoneal access

Abstract

Laparoscopic surgery in urology is definitely incorporated to the techniques of minimally invasive treatment for urogenital diseases. Though the classic access to organs in the urinary tract is extraperitoneal, this access has not been prioritized when the videoendoscopic technique is used. In Brazil, few groups use this approach and little has been discussed about its true practical applicability. The authors intended to discuss the main technical aspects and criteria for indication, reported though the improvement achieved in a 5-year period with 150 operated cases. A review of the literature shows that the worldly acceptance of the extraperitoneal endoscopic approach is increasing. Nevertheless, there are no evidences that the extraperitoneal access is superior to the transperitoneal route. Thus, the choice depends basically on the surgeon's preference. Major advantages are the immediate access to the renal hilum and isolation of peritoneal structures. Employing this access is useful when one suspects that significant peritoneal adherences could prevent the surgical act or when one wishes to preserve the integrity of the peritoneal cavity.

Laparoscopic nephrectomy in inflammatory renal disease: proposal for a staged approach

“…Early access to ing the risk of direct and indirect damage to these structures. In addition to reducing the incidence of adynamic ileus and adhesions, the retroperitoneal access keeps the peritoneal cavity isolated from urinary fistulas and post-operative infectious processes (6,8). This access also enables early control of the renal pedicle, which can result in a major advantage in cases of IRD.…”

Laparoscopic nephrectomy for benign non functioning kidneys

“…In addition to reducing the incidence of adynamic ileus and adhesions, the retroperitoneal access keeps the peritoneal cavity isolated from urinary fistulas and post operative infectious processes. [17] This access also enables early control of the renal pedicle, which can result in a major advantage in case of inflammatory renal disease. Hemal et al reported that the dissection and initial ligation of the renal pedicle in retroperitoneoscopic nephrectomy decreases the index of complication and the conversion rate.…”

Prostatectomía radical endoscópica extraperitoneal: ¿cuál es la pendiente de la curva de aprendizaje? Efectos en la técnica de evolución personal en una experiencia de 5 años

“…Las ventajas de la vía TP son el espacio má s amplio para trabajar, la mayor visibilidad de las estructuras anató micas y, posiblemente, una menor tensió n en la anastomosis uretrovesical. A su vez, la vía EP permite una cirugía má s parecida a la prostatectomía retropú bica abierta y mantiene la integridad de la barrera peritoneal, con lo que entrañ a menos problemas de sangrado postoperatorio, pé rdidas urinarias, íleo y lesió n intestinal 16 .…”