The retroperitoneoscopic approach to renal and adrenal surgery is less popular than the transperitoneal laparoscopic approach, primarily because of its limited working space and surgeons' relative unfamiliarity with the optimal operative technique. Other perceived drawbacks of performing surgery in the retroperitoneum include the abundance of fat and the paucity of easily recognizable anatomical landmarks.

Unlike the peritoneal cavity, the retroperitoneum is a potential, not an actual, space. To create a viable working area, the retroperitoneal space needs to be deliberately expanded. It was not until Gaur (1) described an atraumatic balloon dilation technique to expand the retroperitoneum in 1992 that retroperitoneoscopy became a viable approach to treat urological pathology.

During the past decade, increasing experience at various centers has led to the refinement of laparoscopic techniques that take advantage of the strengths of theretroperi-toneal approach while overcoming its perceived disadvantages (2-9). At our institution, retroperitoneoscopy is a common approach for most renal and adrenal pathology. Presented herein are our current techniques of retroperitoneal laparoscopy (10-14).

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