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A modified access technique for retroperitoneoscopic renal surgery in children
John-Paul Capolicchio1, Roman Jednak, Maurice Anidjar
1Division of Urology, Vermont Children's Hospital, Fletcher Allen Health Care, University of Vermont College of Medicine, 111 Colchester Avenue, Fletcher 4, Burlington, VT 05401, USA.
The Journal of Urology
|June 11, 2003
Summary
This study presents a modified retroperitoneal endoscopic (RPE) access technique for children, minimizing peritoneal entry and gas leaks. This safe and effective method enhances surgical exposure for pediatric procedures.
Area of Science:
- Pediatric Surgery
- Minimally Invasive Surgery
- Urology
Background:
- Retroperitoneal endoscopic (RPE) access in children often leads to peritoneal entry or gas leaks, reducing the retroperitoneal space.
- Existing RPE techniques in pediatric patients can be challenging due to anatomical differences and potential complications.
Purpose of the Study:
- To describe a modified RPE access technique for children that prevents peritoneal entry and gas leaks.
- To facilitate RPE procedures in pediatric patients by optimizing retroperitoneal space.
Main Methods:
- Utilized a modified technique involving initial port placement lateral to paraspinal muscles in the lateral decubitus position.
- Employed blunt dissection and a blunt trocar for initial port insertion, followed by gas insufflation for space creation.
- Ancillary ports were placed, and the telescope repositioned to an anterior subcostal port.
Main Results:
- Eighteen procedures were successfully performed in children (mean age 10.8 years), including nephrectomies and pyeloplasties.
- No gas leaks were observed, with only one minor, unrelated peritoneal entry early in the series.
- Average surgical time for nephrectomy was 178 minutes, with no intraoperative complications.
Conclusions:
- The modified RPE access technique is safe and effective for pediatric patients.
- This approach, based on open lumbotomy principles, minimizes complications and maximizes surgical exposure.
- The technique facilitates RPE by preventing peritoneal entry and gas leaks.