Fig. 3.1
Positioning is important in retroperitoneoscopy. Patient is placed in 90° lateral position with kidney bridge elevation at the level of tip of 12th rib. It helps in opening up the space between the pelvis and the rib cag
Fig. 3.2
12th (or 11th) rib, iliac crest, posterior axillary lineform the important landmarks for retroperitoneoscopy. Marking them initially helps in planning the port sites. Camera port is classically placed just below the tip of the 12th rib. This incision below tip of 12th rib is used to create the retroperitoneal space
Fig. 3.3
Skin and subcutaneous tissue incised initially and white glistening lumbo dorsal facia seen. It is incised sharply using knife or scissors
Fig. 3.4
Finger is used to create retroperitoneal space
Fig. 3.5
Alternatively, spherical balloon trocar may be used to create retroperitoneal space
Fig. 3.6
Retroperitoneal space developed by bulb balloon trocar – Note the bulge anteriorly
Fig. 3.7
Gaur balloon used to create retroperitoneal space – Alternative to balloon tipped trocar
Fig. 3.8
Insertion of working ports with finger guidance prevents inadvertant injury
Fig. 3.9
Insertion of secondary ports – continued
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