Selective approach for transperitoneal and extraperitoneal endoscopic nephrectomy in children

Area of Science:

• Pediatric Urology
• Minimally Invasive Surgery
• Renal Pathology

Background:

• Endoscopic nephroureterectomy is a key treatment for pediatric renal pathology.
• Selecting the appropriate endoscopic approach is crucial for successful outcomes.
• Transperitoneal (TP) and retroperitoneal (RP) approaches offer distinct advantages.

Purpose of the Study:

• To present a logical, selective endoscopic approach for benign renal pathology in children.
• To analyze the outcomes of transperitoneal (TP) and retroperitoneal (RP) endoscopic complete and partial nephroureterectomies.
• To establish decision-making criteria for choosing between TP and RP endoscopic techniques.

Main Methods:

• A 5-year retrospective review of 185 endoscopic nephroureterectomies (122 complete, 63 partial) in children.
• Patient age ranged from 2.7 months to 14 years.
• Key factors for approach selection included renal remnant position, ureteral reflux, and the need for ureterectomy.

Main Results:

• 179 procedures (96.7%) were completed endoscopically, with 6 early open conversions (3.2%).
• Operating times varied by approach complexity, with TP procedures for complex cases taking longer (mean 153 min).
• Hospital stays were shorter for RP and simple TP (mean 1.5 days) compared to complicated TP (mean 3.5 days).

Conclusions:

• A posterior retroperitoneal approach is suggested for isolated renal excision without extensive ureterectomy.
• The lateral retroperitoneal approach is beneficial for complete ureterectomy and complex renal anatomies (horseshoe, pelvic kidneys).
• The transperitoneal approach is recommended for complete moiety excision requiring lower urinary tract reconstruction.