Retroperitonoscopic nephrectomy and nephrouretrectomy in children and adolescents: analysis of a single-center experience.

INTRODUCTION AND OBJECTIVES Retroperitonoscopic nephrectomy in children was considered by some authors to be the final gold standard in children. Hence, we reviewed our data focusing on the safety and efficacy of the procedure. MATERIALS AND METHODS In the period from November 2005 till February 2010, 35 patients were operated by a single surgeon (the first author); patients comprised 18 boys and 17 girls, with a mean age of 7.5 years (range: 1-19 years). In all patients, the retroperitonoscopic approach was used with the use of only three trocars, one 10-mm optic trocar and two 5-mm trocars. The retroperitoneal space was established either by direct insufflation into the Gerota fascia, which is grasped and opened under vision, or using a balloon dilator to widen the space and then incising the Gerota fascia under control of the optic trocar, then control of the pedicle is performed, and the specimen is extracted from the same optic trocar. RESULTS The mean operative time is 75 minutes (range: 45-120 minutes). Nineteen nephrectomies and 16 nephrouretrectomies were performed. Blood loss was minimal, blood transfusion was not given, and conversion to open surgery was not needed. There were no intraoperative complications, and only one postoperative hematoma resolved spontaneously. The mean hospital stay was 2 days (1-3 days). CONCLUSION Retroperitonoscopic nephrectomy in children is safe and feasible. Blood loss is minimal, hospital stay is very short, and complications are minimal. It has excellent cosmetic outcome.