Endoscopic Retroperitoneal Nephrectomy

Abstract

Purpose

: We describe modifications of the retroperitoneoscopic approach to the kidney, including the use of 2-mm instrumentation and prone positioning.

Patients and Methods

: Twenty-one children (13 girls, 8 boys; mean age 2.1 years) have undergone retroperitoneoscopic dissection in the prone position. An inflatable dissecting device was inserted into the retroperitoneum through a small incision at the lateral border of the sacrospinalis muscle, just below the costovertebral angle. After inflation, the dissecting device was replaced with a 5-mm cannula, the pneumoretroperitoneum was maintained with CO₂ insufflation, and two 2-mm trocars were placed with endoscopic guidance. Dissection was performed using 2-mm instrumentation, and the specimen was extracted through the site of the largest port.

Results

: The children underwent nephrectomy, heminephrectomy, or total nephroureterectomy for chronic pyelonephritis with minimal function, reflux or obstruction with nonfunctioning kidney or moiety, multicystic dysplastic kidney, upper pole dysplastic moiety with associated ureterocele, or dysplastic kidney with a vaginal ectopic ureter. The mean operative time for the retroperitoneoscopic dissection was 142 minutes with an estimated blood loss of <15 mL.

Conclusions

: Several modifications to the retroperitoneal approach, including the use of prone positioning and 2-mm instrumentation, provide unobstructed viewing of the kidney and renal hilum and facilitate dissection in a small working space. These modifications may improve the safety and efficacy of this technique in children.