Retroperitoneal laparoscopic access in children using a direct vision technique

Area of Science:

• Urology
• Pediatric Surgery
• Minimally Invasive Surgery

Background:

• Retroperitoneal access for laparoscopic procedures has evolved from balloon dissection to direct visual entry.
• The Visiport visual trocar enables direct visualization during retroperitoneal access.

Observation:

• Thirty-one pediatric patients underwent retroperitoneal laparoscopy for various procedures, including renal biopsy, varicocelectomy, cyst ablation, and pyelolithotomy.
• Procedures were performed with a maximum of three ports, with initial trocar placement under direct vision.
• A working space was created bluntly using the laparoscope for dissection.

Findings:

• All 31 retroperitoneal laparoscopic procedures were successful with minimal blood loss.
• Operative times were generally less than one hour, except for pyelolithotomy (4 hours).
• Patients experienced a mean hospital stay of 1.5 days and returned to normal activity within 6 days, with two minor complications.

Implications:

• Direct visual access to the retroperitoneum is a simple and safe technique for pediatric laparoscopy.
• This approach does not necessitate extensive prior laparoscopic experience.
• It offers a minimally invasive option for various pediatric retroperitoneal conditions.