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Retroperitoneoscopy in the horse: Anatomical study of the retroperitoneal perirenal space and description of a surgical approach.

马的后腹腔镜: 腹膜后肾周间隙的解剖学研究和手术入路的描述。

  • 影响因子:1.86
  • DOI:10.1111/evj.13293
  • 作者列表:"Pujol R","De Fourmestraux C","Symoens A","Branchereau J","Tessier C
  • 发表时间:2021-03-01
Abstract

BACKGROUND:Surgical approaches to the kidneys and perirenal structures are uncommonly performed in horses and several complications have been described with the current procedures. OBJECTIVE:To describe the anatomy of the retroperitoneal perirenal space and investigate a retroperitoneal minimally invasive approach to access the kidney and perirenal structures in horses. STUDY DESIGN:Descriptive, cadaveric study. METHODS:Anatomical description of the retroperitoneal space was performed on three equine cadavers and the surgical approach was developed based on these dissections. Ten cadaveric horses underwent a retroperitoneoscopy. Five horses were placed in a right lateral recumbency position to explore the left retroperitoneal space and five horses were placed in a standing position to explore both left and right sides. Anatomical landmarks, working space and access to the renal hilus and perirenal structures were evaluated. RESULTS:Dissections revealed that kidneys are surrounded by a renal fascia which delimits two spaces: a perirenal space between the kidney and the renal fascia, and a pararenal space between the renal fascia and psoas muscles or peritoneum. The retroperitoneoscopic portal was placed at the level of the dorsal aspect of the tuber coxae, 3 cm caudal to the last rib for the left side and 2 cm caudal to the last rib for the right side. Retroperitoneal access and working space were successfully established in all horses. The standing position allowed an easier dissection than lateral recumbency. Division of the perirenal fat allowed access to the kidney and adrenal glands as well as individualisation of renal vessels and ureter in the renal hilus. MAIN LIMITATIONS:Study of cadavers precluded appreciation of haemorrhage or use the pulsating vessels as landmarks. CONCLUSIONS:This study provides a description of the retroperitoneal perirenal space and describes a new surgical approach to access kidneys and perirenal structures in horses. INTRODUCTION/CONTEXTE:Les approches chirurgicales pour accéder aux reins et aux structures péri-rénales sont réalisées de façon peu fréquente chez le cheval. Plusieurs complications ont été rapportées avec l’utilisation des techniques déjà décrites. OBJECTIFS:Décrire l’anatomie de l’espace péri-rénal rétropéritonéal et investiguer une approche rétropéritonéale minimalement invasive afin d’accéder aux reins et aux structures péri-rénales chez le cheval. TYPE D’ÉTUDE: Descriptive, étude cadavérique. MÉTHODES: La description anatomique de l’espace rétropéritonéal a été effectué en utilisant 3 cadavres équins et l’approche chirurgicale a été développée à partir de ces dissections. Dix cadavres équins ont été soumis à la rétropéritonéoscopie. Cinq chevaux ont été placés en décubitus latéral droit afin d’explorer l’espace rétropéritonéal gauche et cinq chevaux ont été positionnés debout pour pouvoir visualiser à la fois les espaces droit et gauche. Les repères anatomiques, l’espace de travail disponible ainsi que l’accès à l’hile rénal et aux structures péri-rénales ont été évalués. RÉSULTATS: Les dissections ont permis de visualiser les reins entourés d’un fascia rénal séparant l’espace en deux parts : l’espace péri-rénal entre le rein et le fascia rénal ainsi que l’espace para-rénal entre le fascia rénal et les muscles psoas ou le péritoine. La porte rétropéritonéoscopique a été positionnée dorsalement au niveau du tuber coxae, 3 cm caudalement à la dernière côte du côté gauche et 2 cm caudalement à la dernière côte à droite. L’accès rétropéritonéal et à l’espace de travail ont été établis avec succès chez le cheval. La position dorsale permet une meilleure dissection comparativement au décubitus latéral. La séparation du gras péri-rénal permet l’accès au rein et glandes surrénales de même que l’individualisation des vaisseaux rénaux et de l’uretère au sein du hile rénal. LIMITES PRINCIPALES:L’étude cadavérique n’a pas permis l’évaluation du degré d’hémorragie ou la visualisation du pouls sanguin comme repère. CONCLUSIONS:Cette étude offre une description de l’espace péri-rénal rétropéritonéal et décrit une nouvelle approche chirurgicale pour accéder au rein et aux structures péri-rénales chez le cheval. :INTRODUÇÃO: As abordagens cirúrgicas dos rins e das estruturas perirenais são incomuns em equinos e muitas complicações foram descritas com os procedimentos praticados atualmente. OBJETIVO:Descrever a anatomia do espaço perirenal retroperitoneal e investigar uma abordagem retroperitoneal minimamente invasiva para acessar os rins e as estruturas perirenais no cavalo. DELINEAMENTO EXPERIMENTAL:Estudo descritivo em cadáveres. MÉTODOS: A descrição anatômica do espaço retroperitoneal foi realizada em três cadáveres equinos e a abordagem cirúrgica foi desenvolvida com base nestas dissecações. Dez cadáveres equinos foram submetidos à retroperitoneoscopia. Cinco cavalos foram posicionados em decúbito lateral direito para a exploração do espaço retroperitoneal esquerdo e cinco cavalos foram posicionados em pé para a exploração dos lados esquerdo e direito. As referências anatômicas, o espaço de trabalho e o acesso ao hilo renal e às estruturas perirenais foram avaliados. RESULTADOS:As dissecações revelaram que os rins são envoltos por uma fáscia renal que delimita dois espaços: um espaço perirenal entre os rins e a fáscia renal e um espaço pararenal entre a fáscia renal e os músculos psoas ou peritôneo. O acesso retroperitoneoscópico foi posicionado ao nível da face dorsal da tuberosidade coxal, 3 cm caudal à última costela para o lado esquerdo e 2 cm caudal à última costela para o lado direito. O acesso retroperitoneal e o espaço de trabalho foram estabelecidos com sucesso em todos os cavalos. A posição quadrupedal permitiu uma dissecação mais fácil do que o decúbito lateral. A separação da gordura perirenal permitiu o acesso aos rins e às glândulas adrenais, bem como a individualização dos vasos renais e ureter no hilo renal. PRINCIPAIS LIMITAÇÕES: O estudo em cadáveres impediu a avaliação de hemorragia ou o uso de vasos pulsáteis como referências anatômicas. CONCLUSÕES: Este estudo fornece uma descrição do espaço perirenal retroperitoneal e descreve uma nova abordagem cirúrgica para o acesso aoss rins e às estruturas perirenais em cavalos.

摘要

BACKGROUND:Surgical approaches to the kidneys and perirenal structures are uncommonly performed in horses and several complications have been described with the current procedures. OBJECTIVE:To describe the anatomy of the retroperitoneal perirenal space and investigate a retroperitoneal minimally invasive approach to access the kidney and perirenal structures in horses. STUDY DESIGN:Descriptive, cadaveric study. METHODS:Anatomical description of the retroperitoneal space was performed on three equine cadavers and the surgical approach was developed based on these dissections. Ten cadaveric horses underwent a retroperitoneoscopy. Five horses were placed in a right lateral recumbency position to explore the left retroperitoneal space and five horses were placed in a standing position to explore both left and right sides. Anatomical landmarks, working space and access to the renal hilus and perirenal structures were evaluated. RESULTS:Dissections revealed that kidneys are surrounded by a renal fascia which delimits two spaces: a perirenal space between the kidney and the renal fascia, and a pararenal space between the renal fascia and psoas muscles or peritoneum. The retroperitoneoscopic portal was placed at the level of the dorsal aspect of the tuber coxae, 3 cm caudal to the last rib for the left side and 2 cm caudal to the last rib for the right side. Retroperitoneal access and working space were successfully established in all horses. The standing position allowed an easier dissection than lateral recumbency. Division of the perirenal fat allowed access to the kidney and adrenal glands as well as individualisation of renal vessels and ureter in the renal hilus. MAIN LIMITATIONS:Study of cadavers precluded appreciation of haemorrhage or use the pulsating vessels as landmarks. CONCLUSIONS:This study provides a description of the retroperitoneal perirenal space and describes a new surgical approach to access kidneys and perirenal structures in horses. INTRODUCTION/CONTEXTE:Les approches chirurgicales pour accéder aux reins et aux structures péri-rénales sont réalisées de façon peu fréquente chez le cheval. Plusieurs complications ont été rapportées avec l’utilisation des techniques déjà décrites. OBJECTIFS:Décrire l’anatomie de l’espace péri-rénal rétropéritonéal et investiguer une approche rétropéritonéale minimalement invasive afin d’accéder aux reins et aux structures péri-rénales chez le cheval. TYPE D’ÉTUDE: Descriptive, étude cadavérique. MÉTHODES: La description anatomique de l’espace rétropéritonéal a été effectué en utilisant 3 cadavres équins et l’approche chirurgicale a été développée à partir de ces dissections. Dix cadavres équins ont été soumis à la rétropéritonéoscopie. Cinq chevaux ont été placés en décubitus latéral droit afin d’explorer l’espace rétropéritonéal gauche et cinq chevaux ont été positionnés debout pour pouvoir visualiser à la fois les espaces droit et gauche. Les repères anatomiques, l’espace de travail disponible ainsi que l’accès à l’hile rénal et aux structures péri-rénales ont été évalués. RÉSULTATS: Les dissections ont permis de visualiser les reins entourés d’un fascia rénal séparant l’espace en deux parts : l’espace péri-rénal entre le rein et le fascia rénal ainsi que l’espace para-rénal entre le fascia rénal et les muscles psoas ou le péritoine. La porte rétropéritonéoscopique a été positionnée dorsalement au niveau du tuber coxae, 3 cm caudalement à la dernière côte du côté gauche et 2 cm caudalement à la dernière côte à droite. L’accès rétropéritonéal et à l’espace de travail ont été établis avec succès chez le cheval. La position dorsale permet une meilleure dissection comparativement au décubitus latéral. La séparation du gras péri-rénal permet l’accès au rein et glandes surrénales de même que l’individualisation des vaisseaux rénaux et de l’uretère au sein du hile rénal. LIMITES PRINCIPALES:L’étude cadavérique n’a pas permis l’évaluation du degré d’hémorragie ou la visualisation du pouls sanguin comme repère. CONCLUSIONS:Cette étude offre une description de l’espace péri-rénal rétropéritonéal et décrit une nouvelle approche chirurgicale pour accéder au rein et aux structures péri-rénales chez le cheval. :INTRODUÇÃO: As abordagens cirúrgicas dos rins e das estruturas perirenais são incomuns em equinos e muitas complicações foram descritas com os procedimentos praticados atualmente. OBJETIVO:Descrever a anatomia do espaço perirenal retroperitoneal e investigar uma abordagem retroperitoneal minimamente invasiva para acessar os rins e as estruturas perirenais no cavalo. DELINEAMENTO EXPERIMENTAL:Estudo descritivo em cadáveres. MÉTODOS: A descrição anatômica do espaço retroperitoneal foi realizada em três cadáveres equinos e a abordagem cirúrgica foi desenvolvida com base nestas dissecações. Dez cadáveres equinos foram submetidos à retroperitoneoscopia. Cinco cavalos foram posicionados em decúbito lateral direito para a exploração do espaço retroperitoneal esquerdo e cinco cavalos foram posicionados em pé para a exploração dos lados esquerdo e direito. As referências anatômicas, o espaço de trabalho e o acesso ao hilo renal e às estruturas perirenais foram avaliados. RESULTADOS:As dissecações revelaram que os rins são envoltos por uma fáscia renal que delimita dois espaços: um espaço perirenal entre os rins e a fáscia renal e um espaço pararenal entre a fáscia renal e os músculos psoas ou peritôneo. O acesso retroperitoneoscópico foi posicionado ao nível da face dorsal da tuberosidade coxal, 3 cm caudal à última costela para o lado esquerdo e 2 cm caudal à última costela para o lado direito. O acesso retroperitoneal e o espaço de trabalho foram estabelecidos com sucesso em todos os cavalos. A posição quadrupedal permitiu uma dissecação mais fácil do que o decúbito lateral. A separação da gordura perirenal permitiu o acesso aos rins e às glândulas adrenais, bem como a individualização dos vasos renais e ureter no hilo renal. PRINCIPAIS LIMITAÇÕES: O estudo em cadáveres impediu a avaliação de hemorragia ou o uso de vasos pulsáteis como referências anatômicas. CONCLUSÕES: Este estudo fornece uma descrição do espaço perirenal retroperitoneal e descreve uma nova abordagem cirúrgica para o acesso aoss rins e às estruturas perirenais em cavalos.

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