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Modified minimal cost retroperitoneoscopic nephrectomy, nephrectomy with isthumusectomy and nephroureterectomy in
A K Hemal1, N P Gupta, S N Wadhwa
1Department of Urology, All India Institute of Medical Sciences, New Delhi, India.
Objective:
To assess the feasibility of retroperitoneoscopic nephrectomy, nephrectomy with isthmusectomy and nephroureterectomy in children with nonfunctioning kidneys and renal anomalies, at minimal cost using a modified technique.
Patients And Methods:
Eleven children (aged 4-16 years) underwent retroperitoneoscopic nephrectomy, nephroureterectomy, or nephrectomy with isthmusectomy for nonfunctioning kidneys. Three patients had previously undergone percutaneous nephrostomy to evaluate whether the kidney could be salvaged, but this did not alter the success of technique, although adhesions and fibrosis required careful and precise dissection.
Results:
All procedures were completed successfully with minor complications (peritoneal transgression via the port in two patients, with no consequences). The mean operative duration, blood loss and hospital stay were 109 min, 82 mL and 2.25 days, respectively.
Conclusion:
Retroperitoneoscopic procedures can be conducted safely, successfully and at minimal cost without compromising any principles of technique. It is not essential to prepare the bowel or use ureteric catheterization and renal artery embolization. Expensive balloon dissectors, trocar-sealing balloons, endostaplers and endobags, lap sacs or morcellators are not required. The direct approach to the kidney via retroperitoneoscopy is also quicker.