How have extraperitoneal nephrectomy techniques evolved?

Updated: Sep 24, 2019
  • Author: Michael Grasso, III, MD; Chief Editor: Bradley Fields Schwartz, DO, FACS  more...
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Urologists have historically favored a retroperitoneal approach when using open surgical interventions for both renal and adrenal lesions. By maintaining a retroperitoneal surgical field for infectious or malignant processes, the risk of peritonitis or peritoneal seeding was minimized. In addition, this approach helps control and efficiently drain any urinary leakage immediately after renal reconstructive procedures (eg, pyeloplasty, anatrophic nephrolithotomy with infundibuloplasty, partial nephrectomy). Thus, in the age of endoscopic procedures and laparoscopy, crafting surgical interventions that maintain an extraperitoneal surgical field was a natural extension. Ultimately, this evolved into surgical maneuvers that created a potential retroperitoneal space large enough to facilitate both extirpative and reconstructive procedures.

The first retroperitoneoscopy was performed by Bartel et al in 1969 using a mediastinoscope. [5] In 1991, Gauer, the father of modern day retroperitoneoscopy, developed a reliable and effective technique to create a retroperitoneal working space by using a soft inflatable balloon dilator. [6, 7] His initial clinical series of RLNs performed in a series of Indian subjects defined both a safe and effective endoscopic approach to renal lesions. With current high-definition endoscopic imaging and complimentary accessory instrumentation, retroperitoneal laparoscopic renal surgery is regularly performed for both extirpative and reconstructive renal surgery. This approach is particularly suited for radical nephrectomy. With all the advantages of maintaining an extraperitoneal surgical field, and with prompt access to the great vessels and renal vasculature, RLN provides excellent oncologic outcomes with minimal morbidity.

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