Rassweiler J J, Seemann O, Frede T, Henkel T O, Alken P
Department of Urology, Stadtkrankenhaus Heilbronn and Klinikum Mannheim, Clinical Faculty of Medical School, University of Heidelberg, Germany.
J Urol. 1998 Oct;160(4):1265-9. doi: 10.1016/s0022-5347(01)62512-6.
A retroperitoneal access is commonly used for open urological procedures. Since the introduction of the balloon dissecting technique by Gaur this anatomical route has also been used for laparoscopic surgery. We present our experience with retroperitoneoscopy in 200 cases.
From December 1992 to October 1997 a total of 200 retroperitoneoscopic procedures were performed in 197 patients 4 to 82 years old, comprising 78 nephrectomies, 50 renal cyst resections, 14 nephropexies, 11 ureterolyses, 8 retroperitoneal lymph node dissections, 8 renal biopsies, 6 adrenalectomies, 6 heminephrectomies, 6 pyeloplasties, 5 ureterolithotomies, 6 ureterocutaneostomies and 2 others. Of the patients 38 (19%) and 22 (11%) had undergone previous abdominal surgery, and kidney and ureter operations, respectively. Dissection of the retroperitoneal space was enabled by the use of a balloon catheter in 14, balloon trocar system in 93 and finger dissection technique in 93 cases.
We classified 76 procedures (38%) as simple (renal biopsy, renal cyst resections, ureterocutaneostomy), 102 (51%) as difficult (adrenalectomy, nephrectomy, nephropexy) and 22 (11%) as very difficult (pyeloplasty, heminephrectomy, lymphadenectomy). There was a significant learning curve during the first 50 cases reflected by longer operating time, and higher complication, conversion to open surgery and open reintervention rates (14, 10 and 6%, respectively). In addition to the learning curve, mean operating time depended on the difficulty of the procedure, averaging 45 to 100 minutes for a simple, 95 to 185 for a difficult and 185 to 240 for a very difficult retroperitoneoscopy. In the last 50 cases the complication, conversion and reintervention rates (2, 4 and 2%, respectively) were acceptable for routine clinical application.
After experience with more than 200 cases of retroperitoneoscopy the access technique has been significantly simplified. The procedure is standardized, safe and reproducible.
腹膜后入路常用于开放性泌尿外科手术。自高尔引入球囊分离技术以来，这种解剖路径也被用于腹腔镜手术。我们介绍我们200例腹膜后腹腔镜手术的经验。
1992年12月至1997年10月，共对197例年龄在4至82岁的患者进行了200例腹膜后腹腔镜手术，包括78例肾切除术、50例肾囊肿切除术、14例肾固定术、11例输尿管松解术、8例腹膜后淋巴结清扫术、8例肾活检、6例肾上腺切除术、6例半肾切除术、6例肾盂成形术、5例输尿管切开取石术、6例输尿管皮肤造口术及2例其他手术。患者中分别有38例（19%）和22例（11%）曾接受过腹部手术以及肾脏和输尿管手术。14例使用球囊导管、93例使用球囊套管系统、93例使用手指分离技术进行腹膜后间隙的分离。
我们将76例手术（38%）归类为简单手术（肾活检、肾囊肿切除术、输尿管皮肤造口术），102例（51%）归类为困难手术（肾上腺切除术、肾切除术、肾固定术），22例（11%）归类为非常困难的手术（肾盂成形术、半肾切除术、淋巴结清扫术）。在前50例手术中有明显的学习曲线，表现为手术时间更长，并发症、转为开放手术及再次开放干预的发生率更高（分别为14%、10%和6%）。除学习曲线外，平均手术时间取决于手术难度，简单腹膜后腹腔镜手术平均为45至100分钟，困难手术为95至185分钟，非常困难的手术为185至240分钟。在最后50例手术中，并发症、转为开放手术及再次开放干预的发生率（分别为2%、4%和
