Modified Technique for Dissection of Working Space in Retroperitoneal Laparoscopic Surgery

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. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement This study was funded by National Natural Science Foundation of China (NSFC81972841) ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: Institutional Review Board of Jinling Hospital gave ethical approval for this work I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes All data produced in the present study are available upon reasonable request to the authors