Retroperitoneal laparoscopic access in children using a direct vision technique

Purpose: Retroperitoneal procedures were initiated in 1992 by balloon disse ction of the retroperitoneum. More recently a new type of retroperitoneal a ccess has been obtained by directly entering the retroperitoneum using the Visiport visual trocar.* We present our initial experience with direct visu al access to the retroperitoneum in the pediatric population. Materials and Methods: A total of 31 children underwent retroperitoneal lap aroscopy, including renal biopsy in 22, varicocelectomy in 5, renal cyst ab lation in 3 and pyelolithotomy for a staghorn stone in 1. Patients were pla ced in the full flank position. A maximum of 3 ports was used and the initi al trocar was placed under direct vision. The laparoscope was then used to dissect bluntly a working space in the retroperitoneum. Results: All procedures were successful. Blood loss was minimal. Operative time was 4 hours for pyelolithotomy and less than 1 for the other procedure s. Mean hospital stay was 1.5 days and all patients returned to normal acti vity at a mean of 6 days. Two minor complications developed. The peritoneum was inadvertently entered in 1 case, in which no further treatment was nec essary and convalescence was uneventful and short. In another case severe a rrhythmia developed, resulting in an aborted procedure. Conclusions: This technique is simple, safe and does not require extensive laparoscopic experience.