The role of retroperitoneoscopy in the management of renal and adrenal pathology

Objectives To describe the technique, findings and results of retroperitone oscopic ablation of recalcitrant renal, giant adrenal and complex peripelvi c cysts, and nephrectomy for nonfunctioning congenital anomalous kidneys, Patients and methods Nine patients (six men and three women, mean age 56 ye ars, range 44-68, five with renal, two with adrenal and two with peripelvic cysts, diameter 6-14 cm) were treated by retroperitoneoscopic cyst ablatio n using three 10-mm ports. Six further patients (two male and four female, mean age 24 years, range 13-38) underwent retroperitoneoscopic nephrectomy using three or four ports for anomalous nonfunctioning kidneys; three patie nts had a pelvic kidney, two a horseshoe kidney and one an iliac kidney. Is thmusectomy was also performed in the patients with horseshoe kidneys. Results Retroperitoneoscopic cyst ablation was successful in all nine patie nts; the mean (range) operative duration was 69 (50-85) min in patients wit h simple renal and adrenal cysts, and 185 (160-210) min in patients with pe ripelvic cysts. The mean (range) blood loss was 130 (50-200) mt and hospita l stay 2.33 (2-4) days. At the last follow-up, 15-39 months after the proce dure, all patients were asymptomatic and satisfied with the outcome, with n o recurrence of cysts. Retroperitoneoscopic nephrectomy with isthmusectomy (when applicable) was successful in the six patients with anomalous kidneys , with a mean (range) operative duration of 105 (85-120) min; the mean (ran ge) blood loss was 116 (75-150) mt and the analgesic requirement 208 (150-2 50) mg of diclofenac sodium, The hospital stay was 2-3 days and the delay b efore return to preoperative activity 7-14 days. Conclusions Retroperitoneoscopic cyst ablation is a safe and effective meth od to treat symptomatic cysts of the upper urinary tract which are refracto ry to other forms of management. Dissection is difficult in patients with p eripelvic cysts. Retroperitoneoscopic nephrectomy for anomalous kidneys is a challenging procedure because of the abnormal location, anomalous vessels and presence of an isthmus. With advances in laparoscopy and increasing ex perience, open surgery for such conditions is likely to become obsolete.