Modified Technique for Dissection of Working Space in Retroperitoneal Laparoscopic Surgery

Abstract Introduction The existing techniques to creat working space for retroperitoneal laparoscopic surgery are often accompanied by air leakage or poor visibility due to blood and fat tissues smudging during dissection.This single-center experience describes a modified dissection technique to create a retroperitoneal working space during laparoscopic surgery. Materials and Methods From May 2021 to December 2022, we performed a modified dissection technique to create a retroperitoneal working space prior retroperitoneal laparoscopic surgery in 47 patients. During the procedure, laparoscopic dissection is successively performed. The retroperitoneum is initially accessed by puncturing the trocar through a 10-mm transverse skin incision in the midaxillary line. Under endoscopic monitoring, the tip of the trocar is adjusted to a relative avascular layer between the transversus abdominis muscle and the pararenal fat. Laparoscopic dissection is performed to develop until the working space is fully established. All data referring to patient demographics, surgery, dilation-related complication, and perioperative outcomes were collected retrospectively. Results In all cases, a satisfactory retroperitoneal space was created for surgery. The median time of creating retroperitoneal working space was 6 (IQR:5,7) minutes. No dissection-related complications were noted within a median follow-up period of 9 (IQR:7,15) months. Conclusion Modified retroperitoneal dissection with laparoscopy is a safe, simple, effective, and minimally invasive technique. It provides an adequate working space and an excellent view without obvious bleeding.