Retroperitoneal laparoscopy for renal biopsy in children

Purpose: We report our experience with the retroperitoneal laparoscopic app roach for treating pediatric patients and when the percutaneous needle appr oach is not possible due to uncontrolled hypertension, bleeding disorders, anti-clotting medications and anatomical abnormalities. Materials and Methods: Retroperitoneal laparoscopic renal biopsy was perfor med in 20 patients 2 to 18 years old (mean age 9.7) during a 16-month perio d. At the same time 53 percutaneous needle biopsies and 1 open biopsy were performed. The child is in a flank position, and 2 trocars are used via a d irect vision approach. The first trocar is 12 mm. in diameter and positione d on the posterior axillary Line, and the second trocar is 5 mm. in diamete r and is entered 4 cm. anteriorly. Gentle dissection is done to free the lo wer pole of the selected kidney, biopsy forceps are used to grasp the speci men under direct vision and the biopsy site is fulgurated using bipolar ele ctrocautery. Results: Biopsy was performed successfully in all cases except 1, which was converted to an open procedure. Mean operative time was 40 minutes, blood loss was minimal and mean hospital stay was 1.2 days postoperatively. No pa in medication was required postoperatively, and all patients returned to th eir usual activities within 3 to 5 days. A minor intraoperative complicatio n, which was a peritoneal tear with no postoperative sequelae, occurred in 1 case. Conclusions: The retroperitoneal laparoscopic technique is simple and safe, and does not require extensive laparoscopic experience. We believe that th is approach is reliable, and has less morbidity and several advantages comp ared to open surgery. It should be selected as the first choice for treatin g pediatric patients when percutaneous needle renal biopsy is contraindicat ed.