Pediatric retroperitoneoscopic nephrectomy using 2 mm. instrumentation

Joseph G. Borer, Lars J. Cisek, Anthony Atala, David A. Diamond, Alan B. Retik, Craig A. Peters

Research output: Contribution to journalArticle

45 Scopus citations

Abstract

Purpose: We describe several modifications of the retroperitoneoscopic approach to nephrectomy for benign renal disease, including the use of 2 mm. instrumentation and prone patient positioning. Materials and Methods: A total of 14 children underwent retroperitoneoscopic nephrectomy in the prone position. An inflatable dissecting device was inserted into the retroperitoneum after a small muscle splitting incision was made at the lateral border of the sacrospinalis muscle approximately 1 cm. below the costovertebral angle. After inflation the dissecting device was replaced with a 5 mm. cannula and pneumoretroperitoneum was maintained with carbon dioxide insufflation. Two 2 mm. trocars were then placed under endoscopic guidance. Dissection was performed using 2 mm. instrumentation and the specimen was retrieved through the largest port site. Results: Nephrectomy was performed in 9 girls and 5 boys 3 months to 9.8 years old. The preoperative diagnosis included chronic pyelonephritis with minimal renal function, reflux with a nonfunctioning kidney, multicystic dysplastic kidney, an upper pole dysplastic moiety with an associated ureterocele and a dysplastic kidney with a vaginal ectopic ureter. Mean operative time for retroperitoneoscopic nephrectomy was 142 minutes with an estimated blood loss of less than 15 ml. Contralateral ureteral reimplantation was performed after retroperitoneoscopic dissection in 5 patients. Overall average hospital stay was 2 days and there were no complications. Conclusions: Several modifications of the retroperitoneal approach, including the use of prone patient positioning and 2 mm. instrumentation for visualization and dissection, may improve the safety and efficacy of this technique in children.

Original languageEnglish (US)
Pages (from-to)1725-1730
Number of pages6
JournalJournal of Urology
Volume162
Issue number5
DOIs
StatePublished - Nov 1999

Keywords

  • Endoscopy
  • Kidney
  • Miniaturization
  • Nephrectomy

ASJC Scopus subject areas

  • Urology

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    Borer, J. G., Cisek, L. J., Atala, A., Diamond, D. A., Retik, A. B., & Peters, C. A. (1999). Pediatric retroperitoneoscopic nephrectomy using 2 mm. instrumentation. Journal of Urology, 162(5), 1725-1730. https://doi.org/10.1016/S0022-5347(05)68224-9