Conventional laparoscopic surgery requires definite learning curve, and must be converted to an open procedure in the event of a large vessel injury. The usage of carbon dioxide gas for securing operative field is generally accepted, but such
field
rapidly disappears when air pressure decreases. To overcome these shortcomings without sacrificing advantages of excellent cosmetic results and reduced wound pain of laparoscopy without using the gas insufflation, various urologic operationg
utilizing
incisions 2 to 5 cm long were made without cutting abdominal musculature with the help of specially designed retractors and video systems used in conventional laparoscopic surgery. It can be performed in familiar anatomical settings and all the
surgical
skills of open procedures can be utilized.
We have performed 3 living donor nephrectomies, 6 simple nephrectomies, 2 partial nephrectomies, 9 pyeloplasties, 16 ureterolithotomies, 1 ureterourterostomy, and 2 renal cyst marsupializations. Mean operative time and hospital stay were 185
minutes and
7 days for living donor nephrectomies, 160 minutes and 6.7 days for simple nephrectomies, 255 minues and 7.5 days for partial nephrectomies, 130 minutes and 4.8 days for pyeloplasties, 85 minutes and 4.1 days for ureterolithotomies, 90 minuters
and
5
days for ureteroureterostomy, and 75 minutes and 5.5 days for renal cyst marsupializations, respectively . Immediate wound pain was severe probably due to intense traction of abdominal musculature, but the recovery of such pain was remarkably
rapid. No
postoperative wound paresthesia was seen and early discharge was possible.
In conclusion, the gasless retroperitoneoscopically assisted surgery can take advantage of both conventional open and laparoscopic surgery, and it can be a valid option to conventional open surgery for any surgical procedures in retroperitoneum,
including kidney, ureter, and bladder.
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