Retroperitoneoscopic ureterocutanostomy-creating the pneumoretroperitoneum by Visiport

Introduction. Retroperitoneoscopic procedures were already being performed in the late 1970s. The clinical breakthrough of retroperitoneoscopy, however, was initiated in 1992 by baloon-dissecting technique of Gaur, together with the experience gained with transperitoneal laparoscopic procedures in the upper retroperitoneum. Methodes. Our retroperitoneoscopic procedures we had usually performed by baloo-dissecting technique, modified by Rasweiller with hydraulic video-optically controled baloon dissection. For the first time, by this patient were creating the pneumoretropeitoneum using optical troacar-Visiport. In this way we entered the retroperitoneum by visualizating all layers of the abdominal wall. Once inside the retroperitoneum we create the workable space by blunt and sharp dissection under the optical control, avoiding blood vessels and peritoneal lift. Dilatated ureter caused by infiltrative bladder carcinoma was easy identified, clipsed and transsected. Proximal end of the ureter was pulled out through the skin incision for the first troacar. The ureter was spatulated, stented and ureterocutanostomy was performed like by a open surgery operation. Conclusions. Trepanation of the blind insertion is a concern for many surgeons practicing Minimal Invasive Surgery. To eliminate blind insertion and provide an control visualised entry we introduced an optical entry system to retroperitoneum.