Retroperitoneal Method For Kidney Surgery
Most laparoscopic kidney procedures are performed using a transperitoneal (through the abdomen) approach. With this method, the small video telescope that Scott D. Miller, MD uses to see the internal organs is usually placed near the center of the abdomen. The intestines and other vital organs are held in place in order to fully expose the kidney and adrenal gland. Advantages of this approach (compared to the alternative retroperitoneal method) include:
- Most urologists are familiar with this view of the anatomy.
- Easier method to learn
- More room to work
- Best method for robotic kidney procedures
However, the kidney resides behind the abdominal cavity in the retroperitoneal space. With the transperitoneal method, the surgeon must go through one space in order to enter another. For many kidney surgeries, Dr. Scott Miller prefers using the retroperitoneal technique (he has become one of the world’s top experts in this technique) to directly access the kidney through the side of the body. Advantages of this approach (compared to transperitoneal) include:
- He can quickly access the main blood vessels of the kidney prior to any significant manipulation of the kidney. As a result, the potential for bothersome, or even dangerous, bleeding is reduced. For cases involving cancers, communication of the kidney with the rest of the body is reduced very early in the procedure (prior to manipulation).
- Although more difficult to learn, once mastered the retroperitoneal technique is often easier and less time-consuming to perform.
- It allows Dr. Scott Miller to avoid encountering and injuring the intestines and other vital structures within the abdomen, as well as avoiding scar tissue associated with previous surgeries.
- He has better access to the main artery of the kidney and the adrenal gland.
- You have the potential for even quicker recovery and less pain
The technique for the retroperitoneal method involves the following steps:
- You are carefully positioned on your side.
- A small incision is made just below the ribs adjacent to where the elbow would be while in a standing position.
- A small tube is placed through this incision and the retroperitoneal space is expanded with CO2 gas.
- Two additional small tubes are placed – one towards the front of the body and one towards the back.
- Dr. Scott Miller then uses long, skinny instruments to perform the surgery while viewing the internal anatomy on a television monitor.