[Retroperitoneoscopic nephrectomy without pneumoperitoneum--experiments in pigs].

Abstract

Laparoscopic nephrectomy has been performed widely for minimally invasive therapy. However, the procedure of insertion of needles and trocars can cause vascular and intestinal injuries. In addition, pneumoperitoneum using high pressure CO2 gas can cause circulatory and respiratory problems. In order to avoid these problems, we tried retroperitoneoscopic nephrectomy without CO2 gas in 8 kidneys of 4 pigs. A 1.5 cm skin incision was made just below the lowest rib and a small retroperitoneal space was made with the forefinger. The sheath of a 27 Fr rigid nephroscope was covered with a condom balloon and inserted into the retroperitoneal space. Under observing through the nephroscope, the condom was filled with 150-200 ml saline to make a space for the operation. After removing the nephroscope with condom, a scope and trocars were inserted into the space and retroperitoneoscopic nephrectomy was performed. Making the space with condom balloon in the retroperitoneal space was very efficient. The procedures succeeded in 8 and average procedure time was 3 hours. Retroperitoneoscopic nephrectomy without gas is a very attractive minimally invasive technique.