Overview of extraperitoneal laparoscopy.

Recent developments in extraperitoneal endoscopic techniques are causing a second wave of excitement amongst laparoscopic surgeons. In certain situations, there are definite advantages over an intraperitoneal alternative but the new interest of many surgeons for whom this has always been a more natural open route is also very welcome and timely. Many of the frustrating problems of access into the extraperitoneal space have been overcome by the introduction of an expanding dissecting balloon which both creates an adequate working space and tamponades potentially small haemorrhagic vessels torn in the dissection. Routine laparoscopic techniques can then take over using carbon dioxide for insufflation. The major advantage for the patient seems to be reduced post-operative pain but the major problem facing the surgeon is one of orientation in a space where there are no recognisable anatomical landmarks. This problem is being overcome with adjuvant radiological techniques.