Pediatric retroperitoneoscopic nephrectomy using 2 mm. instrumentation

Purpose: We describe several modifications of the retroperitoneoscopic appr oach to nephrectomy for benign renal disease, including the use of 2 mm. in strumentation and prone patient positioning. Materials and Methods: A total of 14 children underwent retroperitoneoscopi c nephrectomy in the prone position. An inflatable dissecting device was in serted 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 endo scopic guidance. Dissection was performed using 2 mm. instrumentation and t he specimen was retrieved through the largest port site. Results: Nephrectomy was performed in 9 girls and 5 boys 3 months to 9.8 ye ars old. The preoperative diagnosis included chronic pyelonephritis with mi nimal renal function, reflux with a nonfunctioning kidney, multicystic dysp lastic kidney, an upper pole dysplastic moiety with an associated ureteroce le and a dysplastic kidney with a vaginal ectopic ureter. Mean operative ti me for retroperitoneoscopic nephrectomy was 142 minutes with an estimated b lood loss of less than 15 mi. Contralateral ureteral reimplantation was per formed 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, includi ng the use of prone patient positioning and 2 mm. instrumentation for visua lization and dissection, may improve the safety and efficacy of this techni que in children.