Retroperitoneal laparoscopic nephrectomy and other procedures in the upper retroperitoneum using a balloon dissection technique.
Retroperitoneal laparoscopic nephrectomy and other procedures in the upper retroperitoneum using a balloon dissection technique.
复制标题
腹膜后腹腔镜肾切除术和使用球囊解剖技术在上腹膜后进行的其他手术。
DOI：
10.1159/000475289
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发表时间：
1994
期刊：
影响因子：
23.4
通讯作者：
P. Alken
中科院分区：
文献类型：
--
作者：
J. Rassweiler;T. Henkel;C. Stoch;M. Greschner;P. Becker;G. Preminger;C. Schulman;T. Frede;P. Alken
本文描述了一种液压球囊剥离技术。腹膜后腔通过背阔肌和外肌边缘之间的小腰背部切口形成，然后在其正确位置可视化后，球囊导管充满500- 1，200 ml温生理盐水（根据患者体型）。该装置由外科医生手套的手指结扎在刚性膀胱导管的末端组成。球囊充气维持5分钟，以保证充分止血。最近，我们用球囊套管针鞘代替了球囊导管，允许直接内镜控制液压剥离。在收回球囊后，将CO2吹入器连接到第一个穿刺器。所有二级套管针均置于内窥镜控制下。水力解剖技术还可以为儿童提供最佳的有效气腹。到目前为止，我们已经使用这种技术在上腹膜后的12个程序，包括5个肾切除术，两个肾输尿管切除术，一个肿瘤肾切除术，一个肾固定术，一个肾囊肿造袋术和两个肾活检。到目前为止，我们没有遇到任何严重的并发症。其中3例肾切除患者既往接受过多次腹部手术干预。腹膜后入路允许外科医生应用与相应开放手术中使用的类似解剖技术。它已成为腹腔镜手术的良性肾脏疾病的常规方法。即使以前接受过腹部手术，也可以进行该手术。
This article describes a hydraulic balloon dissection technique. The retroperitoneum is developed via a small lumbodorsal incision between the edges of the musculus latissimus dorsi and musculus obliquus externus and then after visualization of its correct position the balloon catheter is filled with 500-1,200 ml of warm normal saline (according to patient size). The device consists of the finger of a surgeon's glove ligated around the end of a rigid bladder catheter. The balloon insufflation is maintained for 5 min to guarantee adequate hemostasis. Recently, we have replaced the balloon catheter by a balloon trocar sheath allowing direct endoscopic control of the hydraulic dissection. After retrieval of the balloon the CO2 insufflator is connected to the first trocar. All secondary trocars are placed under endoscopic control. The hydraulic dissection techniques also enable optimal creation of an effective pneumoperitoneum in children. Until now, we have used this technique for twelve procedures in the upper retroperitoneum including five nephrectomies, two nephroureterectomies, one tumor nephrectomy, one nephropexy, one renal cyst marsupialization and two renal biopsies. Up to now we have encountered no major complications. Three of the nephrectomized patients had undergone multiple previous abdominal surgical interventions. The retroperitoneal approach allows the surgeon to apply similar dissecting techniques as used in respective open procedures. It has become the routine approach for laparoscopic procedures in benign renal disease. This procedure can be performed even in cases with previous abdominal surgery.