This video demonstrates the transvaginal approach to the retroperitoneal space.
A posterior colpotomy is carried out with the needle-knife. The retroperitoneal space is entered digitally enlarging the posterior vaginal incision. In order to avoid peritoneal entering, precise identification of key anatomical landmarks is mandatory. A retroperitoneal tunnel is created using both blunt and balloon dissection with the assistance of CO2 insufflation set at 12mmHg. Demonstrated herein are the technical steps of right adrenalectomy, left nephrectomy and a right latero-caval lymphadenectomy.

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