Taking the side of transperitoneal access for surgery in upper urinary tract

Abstract

Laparoscopic surgery has become a preferred treatment option for the management of upper urinary tract pathology. Large series of complex urologic operations have been published, with favorable outcomes. Although the early experience with urologic laparoscopy consisted almost exclusively of transperitoneal procedures, some surgeons prefer the retroperitoneal approach. The debate of retroperitoneal versus transperitoneal laparoscopy for upper tract pathology is complex because comparative and randomized studies are lacking. In contrast to the retroperitoneal approach, transperitoneal laparoscopic procedures allow for a larger working space, adequate maneuverability, and the presence of familiar anatomic landmarks. This article highlights our experiences and approaches to major laparoscopic upper urinary tract surgery for benign and malignant conditions. A summary of the published literature as it pertains to the transperitoneal approach also is presented.

A two-center experience with the exclusive use of laparoscopic transperitoneal nephrectomy for benign renal disease in children

“…For pediatric surgeons familiar with the layout of the abdominal cavity, the LTP approach represents a natural progression from performing laparotomies [1]. The anatomic landmarks are easily identifiable, and the working space is sufficient for instrument maneuverability and specimen mobilization.…”

Adrenal gunshot wound: Laparoscopic approach. Report of a case

“…We used Veress needle to induce pneumoperitoneum and three trocars in the left subcostal region. In contrast to retroperitoneal approach, we chose a transperitoneal laparoscopic procedure because allows for a larger working space, adequate maneuverability and the presence of familiar anatomic landmarks 9 . Careful exploration of the peritoneal cavity did not show lesions of the peritoneal organs.…”