Different Ways Of Establishing Retroperitoneal Space In Urologic Surgery

Part Ⅰ. Three different ways of establishing retroperitoneal space in urologic surgeryObjective:To compare the establishing time, security, intra-postoperative complications of three different ways of establishing the retroperitoneal space in urologic surgery.Methods:From December2010to December2012,810patients were performed laparoscopy via retroperitoneal approach. According to the different ways of establishing the retroperitoneal space, they wre separated into three groups randomly:group A, B and C. Group A uesd balloon technique to build up the retroperitoneal space, Group B uesd finger separation technique, Group C uesd IUPU (the acronym of Institute of Urology, Peking University) technique. We recorded the establishing time, intra-postoperative complications, evaluated the effect on surgery and followed up the wound healing.Results:All cases were successful in establishing the retroperitoneal space except one in group A, which was converted to open surgery because of balloon burst. The space we builded was big enough for surgery. The establishing time was7.3±3.2min (group A),4.8±2.8min (group B) and3.7±1.8min (group C), the difference had statistical significance. All the incisions healed well. However,14cases in group A had waist bulging after surgery with no obviously uncomfortable. There were no significant post-operative complications in all cases.Conclusions:IUPU technique was simple, convenient and time-saving with smaller incision. The balloon technique took longer time with the problem of balloon burst and waist bulging, while the finger technique between them. So, we could use the IUPU technique to expand retroperitoneal space in the future, while the traditional balloon technique confirmed no advantage. Part Ⅱ. The application of different ways in establishing retroperitoneal space for single-site laparoscopic renal cysts surgery: a prospective studyObjective:To report and prospectively compare the application of two different ways of establishing retroperitoneal space in single trocar laparoscopic renal cysts decortication.Methods:From April2010to January2013,102patients were performed single trocar laparoscopic renal cysts decortication via retroperitoneal approach. All the patients were selected according to the inclusion criteria. According to the different ways of establishing retroperitoneal space, they wre separated into two groups randomly:group A and B. Group A uesd IUPU (the acronym of Institute of Urology, Peking University) technique to build up the retroperitoneal space, Group B uesd balloon technique.The surgerys were completed by the same surgeon.Results:102cases were successful with single-site, while Group A and B respectively had one case adding a5-mm trocar because of the conglutination between cysts and other organs, and Group A has another case adding trocar because of bleeding. The establishing time was3.5±1.2min (group A) and6.2±2.3min (group B), the difference had statistical significance. The operation time was58.7±21.1min (group A) and 49.3±18.9min (group B), the difference had statistical significance. Less blood loss during operation, hospital stay after operation was2-3days. No case relapseed and the renal function were normal in a1-3months follow-up. There were no significant postoperative complications.Conclusions:The balloon technique profits the operation because of the bigger working space it provided, though it takes longer time in establishing retroperitoneal space.We can use the balloon technique in single trocar laparoscopic renal cysts decortication.