Controlled Balloon Dilatation of the Extraperitoneal Space for Laparoscopic Urologic Surgery

Abstract

Laparoscopic urologic surgery has become increasingly more popular, with the majority of procedures and techniques that have been described based on intraperitoneal experience and anatomic considerations. Urologic surgery, traditionally confined mostly to the extraperitoneal space, has followed these intraperitoneal descriptions when undertaken laparoscopically. Our experience of controlled, laparoscopically monitored dilatation of the extraperitoneal space using a new trocar-mounted balloon dissector can create a working space in a surgical environment familiar to traditional open urologic surgery. We report our initial experience with the preperitoneal distention balloon in 15 patients, emphasizing the technique of extraperitoneal access and the laparoscopic visualization of anatomy relevant to pelvic lymph node dissection, varicocele ligation, nephropexy, and renal biopsy. In this early experience, laparoscopic pelvic lymph node dissection was performed successfully in 7 of 11 patients and in all other patients undergoing the retroperitoneal procedures. Patients with a prior history of hernia repair or appendectomy do not appear to be suitable to this approach when used for pelvic lymphadenectomy. The trocar-mounted balloon device allows direct visualization and control of the dissection process. Avoiding the transperitoneal approach may eliminate many of the complications associated with the transperitoneal access and procedure completion. We conclude that the extraperitoneal technique using this device merits further investigation and more widespread application in the laparoscopic approach to conventional extraperitoneal urologic procedures.

Laparoscopic urological surgery: 1994

“…More extensive procedures such as organ entrapment for nephrectomy are potentially more difficult in the retroperitoneum due to the smaller working space. Preliminary work with extraperitoneal lymphadenectomy and bladder neck suspension has been reported by several groups [32,33]. Hirsch et al note that patients who have undergone prior pelvic surgery (hernia repair, appendicectomy) may not be suitable candidates for the extraperitoneal pelvic approach due to difficulty developing the extraperitoneal space [ 321.…”

Balloon Dilators for Fast and Safe Flap Dissection in Transoral Endoscopic Vestibular Approach Thyroidectomy Vestibular Approach (TOETVA)

“…Balloon dilators are inflatable balloons that are inserted between desired tissue planes and inflated to separate tissue layers along naturally occurring planes to create working space. The use of balloon dilators is common in various endoscopic or laparoscopic surgeries, including inguinal hernia, renal, and urologic surgeries (4)(5)(6). The use of balloons for inguinal hernia dissection has been shown to offer faster operation time, reduce the rate of conversion to open surgery, and reduce postoperative pain, without increasing postoperative complications (7,8).…”

Small-Incision Laparoscopy-Assisted Surgery Under Abdominal Cavity Irrigation in a Porcine Model

“…Membranous bags have been used to wrap the intestines to avoid desiccation during open surgery, and distention balloons have been used to create surgical space in laparoscopic surgery. 14 Such devices could also be used to keep the surgical field clear under irrigation. Kamiyoshihara et al 15 introduced a unique vacuum-packing technique to extract resected tissues from the thoracic cavity.…”