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 nephro-ureterectomy 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.
ASJC Scopus subject areas
- Pediatrics, Perinatology, and Child Health