Retroperitoneoscopic Nephrectomy in the Prone Position in Children (Point of Technique)

Current indications for laparoscopy and retroperitoneoscopy in pediatric urology

“…Multicystic renal dysplasia and nonfunctioning kidneys because of obstructive uropathy with the kidney in the orthotopic renal fossa position, and also upper moiety duplex with a nonrefluxing ureter or reflux nephropathy in children younger than 5 years were selected for posterior lumboscopic or retroperitoneoscopic nephrectomy [33]. Nephrectomy for nonfunctioning reflux nephropathy kidneys or duplex moiety necessitating resection of a grossly dilated megaureter, especially in children older than 5 years preferably is undertaken via a lateral extraperitoneal approach [30]. Finally, nephrectomy for small dysplastic a˜invisiblea˜kidneys associated with ureteric ectopia and urinary incontinence as well as complex duplex excision with extensive ureterocelectomy and lower urinary tract reconstruction should be performed via a transperitoneal laparoscopic approach [35].…”

“…A retroperitoneal chamber is created with either balloon dissection or a simple dissection using the tip of the laparoscope and pneumodissection. In general, two more trocars are used for triangulation [30,33].…”

“…The first cases reported in the international literature were managed using the transperitoneal approach, but the subsequent reports of nephrectomy, mainly involving children, were based on retroperitoneoscopy [10,18,28]. Since then, more than 500 videosurgical nephrectomies have been performed worldwide [18,30].…”

“…In cases of vesicoureteral reflux associated with a grossly refluxing megaureter, the ureter must be sectioned near the ureterovesical junction at the level of the bladder, whereas in the absence of a grossly refluxing megaureter, the ureter can be divided either by electrocautery or between ligatures or clips at a conveninent distance from the renal tissue [30,33]. The extraction of the kidney can be achieved from the optic's orifice, enlarged if necessary, or with the aid of a plastic bag.…”

“…Although the specific indications will continue to be defined, they generally include adrenal benign cysts, pheochromocytoma, adenoma, and aldosteronoma. In the case of neuroblastoma or other malignant tumors affecting children, it is preferable to adopt an open traditional approach [3,30]. A good knowledge of the adrenal pathophysiology and surgical anatomy is fundamental to the success of this procedure.…”