Laparoscopic renal surgery via a retroperitoneal approach in children

Laparoscopic procedures are still not widely performed by pediatric urologists due to operative time and costs as well as the lack of indications and, thus, the lack of sufficient surgeon experience. We report our experience with the retroperitoneal approach using special inexpensive methods for various indications in children.

From 1994 to 1997 we performed 42 retroperitoneal laparoscopic procedures in 41 children with a mean age of 4 years, including 31 nephrectomies, 8 partial nephrectomies, 2 renal cystectomies and 1 pyelolithotomy. A total of 13 patients were younger than 1 year. Followup ranged from 6 months to 3 years.

Mean operative time was 104 minutes (range 35 to 150) for nephrectomy, 153 (range 90 to 210) for upper pole nephroureterectomy, 135 for pyelolithotomy and 60 for renal cystectomy. Average postoperative stay was 2 days. Conversion was required in 2 cases of partial nephrectomy due to unidentified polar vessels, including 1 involving duodenal perforation.

The indications for retroperitoneal laparoscopy are expanding with the experience of the surgical team. The retroperitoneal approach provides a technique comparable to that of conventional renal surgery.