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HOW RETROPERITONEAL LAPAROSCOPY WAS MADE POSSIBLE BY DR GAUR
WHEN IN 1991 DR GAUR VISITED CLEVELAND CLINIC FOUNDATION, CLEVELAND, OHIO, USA, HE CAME TO KNOW THAT DR RALPH CLAYMAN OF WASHINGTON UNIVERSITY HAD CREATED HISTORY BY PERFORMING THE FIRST LAPAROSCOPIC NEPHRECTOMY (REMOVAL OF A DISEASED KIDNEY). DR GAUR STARTED WONDERING WHY IT WAS NOT PERFORMED LAPAROSCOPICALLY BY THE MORE DIRECT APPROACH THROUGH THE LUMBAR REGION, WHICH IS NORMALLY USED BY THE SURGEONS FOR AN OPEN NEPHRECTOMY.
AFTER DR GAUR RETURNED TO INDIA IN JULY, HE STARTED EXPLORING THE POSSIBILITY OF PERFORMING LAPAROSCOPIC OPERATIVE PROCEDYRES FOR RETROPERITONEAL STRUCTURES LIKE THE KIDNEY, THE URETER, THE ADRENAL GLAND ETC USING THE MORE DIRECT LUMBAR RETROPERITONEAL APPROACH.
THE PROBLEM WITH THE RETROPERITONEAL APPROACH WAS THAT LIKE THE NATURALLY EXISTING PERITONEAL SPACE FOR THE INDIRECT TRANSPERIRONEAL APPROACH, THERE WAS NO SPACE AVAILABLE FOR THE DIRECT LUMBAR APPROACH. FOR A LAPAROSCOPIC OPERATIVE PROCEDURE IT IS VERY ESSENTIAL TO HAVE A SPACE NEXT TO THE ORGAN SO THAT THE SPACE CAN BE DISTENDED WITH GAS AND VARIOUS INSTRUMENTS INSERTED THROUGH ACCESSORY PORTS FOR PERFORMING THE OPERATIVE PROCEDURE. THIS HAD BEEN THE STUMBLING BLOCK FOR THE LAPAROSCOPIC SURGEONS WHO HAD ATTEMPTED SURGERY BY THE MORE DIRECT LUMBAR APPROACH. THE RETROPERITONEAL APPROACH, IN ADDITION TO BEING EASY AND DIRECT, ALSO HAS THE ADVANTAGE OF NOT TRANSGRESSING THE PERITONEAL CAVITY, THEREBY MAKING IT A SAFER PROCEDURE.
WHEN DR GAUR ONE DAY SAW A PATIENT WITH A LARGE RETROPERITONEAL CYST, JUST BEHIND THE KIDNEY, HE GOT THE IDEA OF MAKING A TEMPORARY ARTIFICIAL CYST BEHIND THE KIDNEY TO MAKE IT POSSIBLE FOR THE SURGEON TO SUCCESSFULLY PERFORM A SURGICAL PROCEDURE USING THE MORE DIRECT AND SAFER LUMBAR RETROPERITONEAL APPROACH.
DR GAUR USED A BALLOON MADE OF A SURGICAL GLOVE TO CREATE A SMALL SPACE BEHIND THE KIDNEY TO SUCCESSFULLY REMOVE A STONE FROM THE URETER BY THE RETROPERITONEAL LAPAROSCOPIC APPROACH IN 1991.
WELL, THIS WAS THE BEGINNING OF A NEW ERA IN LAPAROSCOPY, AND DR GAUR SURPRISED THE WORLD LEADERS BY PERFORMING ALL TYPES OF SURGERY ON STRUCTURES ON THE BACK WALL OF THE ABDOMEN, USING HIS INNOVATIVE BALLOON TECHNIQUE OF RETROPERITONEAL LAPAROSCOPY.
THE TECHNIQUE HAS NOW BEEN WELL ESTABLISHED AND IS BEING USED REGULARLY ALL OVER THE WORLD.Other Places to go:
