Direct carbon dioxide insufflation of the retroperitoneum under laparoscopic control for renal and adrenal surgery.

OBJECTIVE Assessment of the videoscopic approach to the retroperitoneal space in the vicinity of the kidney and the adrenal gland. DESIGN Open study. SETTING University hospital, Belgium. SUBJECTS 10 patients who underwent 11 operations (adrenalectomy, n = 3, nephrectomy, n = 5, partial nephrectomy, n = 2, and renal cystectomy, n = 1). INTERVENTIONS Direct CO2 insufflation of the retroperitoneal space in order to obtain a convenient retroperitoneal working space for renal and adrenal surgery. OUTCOME MEASURES Feasibility, morbidity and mortality. RESULTS 8 patients were operated on exclusively by the retroperitoneoscopic approach; 2 required the retroperitoneal and transperitoneal routes to be combined to complete an adrenalectomy. No patients required blood transfusion and no patient died. Median postoperative stay was 3 days. CONCLUSION The CO2 insufflation technique of the retroperitoneum is safe and reproducible. Nevertheless, far from excluding each other, both approaches-laparoscopic and retroperitoneoscopic-are complementary in difficult cases, particularly for adrenal endoscopic surgery and for larger renal lesions.