Balloon Assisted Extraperitoneal Laparoscopic Approaches.

Laparoscopic techniques may be applied to structures with an extraperitoneal locale, without the use of generalized intraabdominal gas insufflation. Pelvic lymphadenectomy, bladder neck suspension, inguinal hernia repair, and renal access may be accomplished outside the abdominal cavity. This approach allows local or regional anesthesia to be applied in a variety of laparoscopic procedures. Formation of a working cavity via blunt dissection of the peritoneum away from the organ of interest permits instrument insertion and manipulation in the extraperitoneal space. Peritoneal displacement is performed using a balloon cannula that incorporates an endoscope to permit direct visual monitoring of the dissection process. Separate versions of transparent elastomeric and nonelastomeric balloon cannulae have been developed to achieve dissection configurations tailored to the anatomic requirements of the specific procedures. Between January 1993 and January 1994, balloon-assisted extraperitoneal dissection was performed in 3,750 patients. No incidence of epigastric vessel avulsion has been noted during preperitoneal cavity dissection, and the technique has facilitated the process of extraperitoneal surgical exposure.