Retroperitoneoscopy and Extraperitoneal Laparoscopy in Pediatric and Adult Urology


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Seven patients had persistent fever after surgery; the other postoperative complications included wound infection and pleural effusion. Most of these conversions were elective because it was not possible to proceed laparoscopically. Five were emergency explorations to control haemorrhage or deal with a colonic perforation. The incidence of complications in relation to increasing experience is shown in Fig.

There are inherent advantages in retroperitoneoscopy over transperitoneal laparoscopy [ 4 , 5 , 8 , 11 , 14 ]. The direct approach to the retroperitoneum avoids peritoneal transgression; this minimizes the risk of intraperitoneal injury during colonic mobilization, postoperative adhesions and peritonitis if there is spillage of infected renal contents. Complications during retroperitoneal surgery can be broadly classified into those of access, dissection, wound healing and associated trauma [ 10 ].


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Among the complications of access and dissection, peritoneal tears are the most common. This problem occurred in 17 5. A peritoneal tear may occur either when inserting the ports or during the dissection. Placing each port under direct vision, especially those placed along the anterior axillary line, can prevent tears. Another preventive measure is a full lateral tilt of the patient to allow the peritoneum and bowel to displace from the site of the primary port. This allows the peritoneum to be manually reflected away before inserting the trocar.

However, this requires a large primary port incision and increases the chances of subcutaneous emphysema, especially if a port with a subfascial retention balloon is not used. If a tear does occur, the problem can be managed using a variety of techniques. An intravenous cannula can be inserted into the peritoneum to vent the CO 2.

Retroperitoneoscopy and Extraperitoneal Laparoscopy in Pediatric and Adult Urology

This helps to increase the retroperitoneal space by reducing the intraperitoneal pressure. Another option is to widen the tear intentionally to equalize the pressure on the two sides. These manoeuvres are usually sufficient to overcome the problem. At the end of the procedure, peritoneoscopy can be used to confirm that there is no visceral injury. Another option to avoid open surgery is to convert to a transperitoneal laparoscopic procedure.

Laparoscopic retroperitoneoscopic nephrectomy and partial nephrectomy in children

This technique provides inadequate space in the retroperitoneum and unlike the balloon, does not aid in dissecting the kidney. Subcutaneous emphysema caused by the leakage of CO 2 from around the port sites occurred in seven of the present patients. We have since modified the primary port placement technique and take care to: i avoid creating any planes between the skin, subcutaneous tissue and muscle layers; ii make only a small incision in the thoracolumbar fascia; and iii place silk sutures through all layers of the abdominal wall to fix the port cannula.

The last may be difficult in an obese patient and in such cases it may be prudent to use a cannula with a subfascial retention balloon. This occurred in four patients, including two with renal tuberculosis undergoing nephrectomy.

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This problem highlights one of the advantages of retroperitoneoscopy over transperitoneal surgery, where such spillage may have led to peritonitis. Vascular injuries constitute most major complications encountered during laparoscopic surgery [ 4 , 5 , 10 , 16 ]. These include injuries while inserting the ports and during dissection. One patient required open surgery but the rest were managed endoscopically. They found that these injuries occurred more often during complex laparoscopic procedures and in patients who had undergone previous ipsilateral retroperitoneal surgery.

Fahlenkamp et al. In the present series, major vascular events occurred in seven 2. Bleeding from gonadal vessels and their retroperitoneal branch vessels occurred towards the end of the procedure during blunt dissection of the kidney and ureter; this problem occurred in three patients. While it could be endoscopically controlled in two, one required conversion to open surgery.

The bleeding is tamponaded by the pneumoretroperitoneum during the procedure but once the positive pressure is released, bleeding recurs. Minor bleeds may stop spontaneously, but proper endoscopic control by clipping the bleeding vessel helps reduce the blood loss and possible need for transfusion. The patient was a small woman and the space in the retroperitoneum was inadequate to completely insert the metal trocar and cannula.

In such patients the port should be placed under manual rather than visual guidance. Colonic injury occurred in one patient who had previously undergone pyelolithotomy for calculus disease through the flank approach and had significant perirenal fibrosis. The colon was injured while attempting to dissect the renal hilum in the dense fibrosis, and was repaired during open surgical nephrectomy.

In patients undergoing nephrectomy and with a history of previous surgery or recurrent episodes of pyelonephritis, fewer adhesions are encountered if the dissection is outside Gerota's fascia, as in a radical nephrectomy. Therefore in difficult situations, such an initial approach outside Gerota's hilum is preferable.

They advocated organ entrapment and morcellation or retrieval through a midline incision. In all the present patients the specimen was removed intact, either by enlarging the primary port site or by joining two adjacent ports.

CILR 2008 - Vincenzo Disanto - Retroperitoneal nephrectomy

The book addresses urologists, general and abdominal surgeons, pediatric urologists and pediatric surgeons who are interested in minimally invasive procedures and particularly in retroperitoneal laparoscopy. JavaScript is currently disabled, this site works much better if you enable JavaScript in your browser. Medicine Urology.

Free Preview. The volume comprises contributions by internationally renowned authors and is a complete overview of the technique for those who are interested in minimally invasive procedures and particularly in retroperitoneal laparoscopy. Buy eBook. Buy Softcover. FAQ Policy. About this book Laparoscopy is a new frontier of the surgical technique, which recently gained more and more popularity and credit upon the surgical teams, also in Urology.

Show all. E-mail: as. Received Aug 17; Accepted Sep This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3. This article has been cited by other articles in PMC. Abstract Objectives: The aim was to evaluate our experience in the retroperitoneal laparoscopic approach in total and partial nephrectomies in children. Materials and Methods: We retrospectively reviewed the medical records of 41 patients who underwent retroperitoneal laparoscopic total or partial nephrectomies performed in our center from to Results: Thirty-five total and six partial nephrectomies upper pole were performed.

Conclusions: Laparoscopic retroperitoneoscopic renal surgery can be carried out safely and effectively in children. Keywords: Children, laparoscopy, nephrectomy, partial nephrectomy, retroperitoneal. Open in a separate window. Figure 1.

Figure 2. Figure 3. Table 1 Demographic data and general findings. Table 2 Underlying diagnosis distribution. Table 3 Comparison between total and partial nephrectomy. Retroperitoneal laparoscopic nephrectomy in children: At last the gold standard? J Pediatr Urol. El-Ghoneimi A. Renal dysplasia and cystic disease options. In: Docimo SG, editor. Minimally Invasive Approaches to Pediatric Urology. London: Taylor and Francis; Laparoscopic transperitoneal partial nephrectomy in children under 2 years old: A single-centre experience.

Kundrecensioner

Retroperitoneal laparoscopic heminephrectomy in duplex kidney in infants and children: A year experience. Eur Urol. Current indications for laparoscopy and retroperitoneoscopy in pediatric urology. Surg Endosc. Pediatric retroperitoneal laparoscopic nephrectomy. J Endourol. Pediatric retroperitoneoscopic nephrectomy using 2 mm. J Urol. Retroperitoneal laparoscopic nephrectomy in children. Nephrectomy: A comparative study between the transperitoneal and retroperitoneal laparoscopic versus the open approach.

Laparoscopic renal surgery via a retroperitoneal approach in children.


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Gaur DD. Laparoscopic operative retroperitoneoscopy: Use of a new device. Laparoscopic transperitoneal and retroperitoneal nephrectomies in children: Achange of practice. Pediatric retroperitoneal laparoscopic partial nephrectomy: Comparison with an age matched cohort of open surgery. Retroperitoneal laparoscopic vs open partial nephroureterectomy in children. BJU Int. Comparison of laparoscopic versus open partial nephrectomy in a pediatric series.

Retroperitoneal laparoscopic nephrectomy in children younger than nine years-old: State of the art. Acta Med Port. Laparoscopic nephrectomy in children: Systematic review of transperitoneal and retroperitoneal approaches. Retroperitoneal laparoscopic nephrectomy: The effect of the learning curve, and concentrating expertise, on operating times.

Outcomes and fate of the remnant moiety following laparoscopic heminephrectomy for duplex kidney: A multicenter review.

Retroperitoneoscopy and Extraperitoneal Laparoscopy in Pediatric and Adult Urology Retroperitoneoscopy and Extraperitoneal Laparoscopy in Pediatric and Adult Urology
Retroperitoneoscopy and Extraperitoneal Laparoscopy in Pediatric and Adult Urology Retroperitoneoscopy and Extraperitoneal Laparoscopy in Pediatric and Adult Urology
Retroperitoneoscopy and Extraperitoneal Laparoscopy in Pediatric and Adult Urology Retroperitoneoscopy and Extraperitoneal Laparoscopy in Pediatric and Adult Urology
Retroperitoneoscopy and Extraperitoneal Laparoscopy in Pediatric and Adult Urology Retroperitoneoscopy and Extraperitoneal Laparoscopy in Pediatric and Adult Urology
Retroperitoneoscopy and Extraperitoneal Laparoscopy in Pediatric and Adult Urology Retroperitoneoscopy and Extraperitoneal Laparoscopy in Pediatric and Adult Urology
Retroperitoneoscopy and Extraperitoneal Laparoscopy in Pediatric and Adult Urology Retroperitoneoscopy and Extraperitoneal Laparoscopy in Pediatric and Adult Urology
Retroperitoneoscopy and Extraperitoneal Laparoscopy in Pediatric and Adult Urology Retroperitoneoscopy and Extraperitoneal Laparoscopy in Pediatric and Adult Urology

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