Retroperitoneoscopy: A Versatile Access for Many Urologic Indications

Abstract Objectives Current indications of retroperitoneoscopy have been extended to oncologic operations (radical nephrectomy, nephroureterectomy, retroperitoneal lymph node dissection) and complex reconstructive procedures (pyeloplasty, partial nephrectomy). Our single-institution experience focuses on feasibility and complications of retroperitoneoscopy performed over 9 yr. Methods Between 1997 and 2006, 6 staff surgeons and 10 fellows at our institution performed 692 retroperitoneal procedures. Using this technique, 17 different procedures were performed. These operations were classified according to their technical difficulty and operative risk. Intraoperative major complications were analysed and postoperative complications were stratified into five grades using the modified Clavien classification system. Results Procedures were classified as simple in 76 patients (10.9%), difficult in 471 (68%), and very difficult in 145 (20.9%). The mean operation time was 145.2±89.7min (range: 30–270min). Intraoperative major complications, including open conversion in 1.4%, were observed in a total of 15 patients (2.2%). A total of 76 patients (10.9%) patients had postoperative complications: grade I in 12 (1.7%), grade II in 51 (7.3%), grade IIIa in 2 (0.2%), grade IIIb in 10 (1.4%), and grade IV in 1 (0.1%). Major intraoperative and postoperative complication rates depended on the difficulty of the procedure but diminished over the years with increased experience of the surgeons. Conclusions Retroperitoneoscopy has proven to be an excellent approach with certain advantages (early control of renal hilum, minimal risk of abdominal complications, and feasibility in cases of previous abdominal surgery). It represents a well-standardised and transferable procedure on kidney, adrenal, ureter, and lymphatics.