Anterior approach retroperitoneal laparoscopic renal surgery in children

Retroperitoneoscopic renal surgery is performed by lateral or posterior approaches. Iterative modification led to development of an alternative 'anterior' approach. The study authors' experience with this novel approach in a prospective series of 69 children that includes 17 infants is reported. Mean operating time was 225 min for reduction pyeloplasty. Peritoneal tear is not uncommon (22%) but often does not require conversion. In the study authors' early experience, the conversion rate was 17% and postoperative complications 2.9%. This approach overcomes many existing challenges with retroperitoneoscopy. Benefits of exposure, orientation, and working space achieved with a transperitoneal approach are afforded while preserving the advantages of retroperitoneoscopy.