Retroperitoneoscopic nephroureterectomy via three trocars in pediatric patients with end-stage reflux nephropathy

PubMedID: 20879861Background and Purpose: In children with end-stage reflux nephropathy, nephroureterectomy can be performed either open or laparoscopically. It is not common to use a three-trocar retroperitoneal approach for nephroureterectomy with complete ureteral excision in the pediatric age group. We report the results of pediatric retroperitoneoscopic nephroureterectomies by using three trocars only. Patients and Methods: Between August 2003 and November 2009, 13 children-seven boys and six girls-with end-stage reflux nephropathy underwent retroperitoneoscopic nephroureterectomy. The operations were performed by using three trocars with the patient in a flank position under general anesthesia. Renal blood vessels were individually dissected and divided followed by the transection of the ureter at the level of the ureterovesical junction. Results: The mean age of the patients was 6.5±4.4 years (15 months-14 years). Eight of the operations were performed on the left and five on the right side. Mean operative time was 137±47 minutes (75-230min). Estimated blood losses were minimal. Mean hospitalization time was 2.2±0.9 days (2-5 d). No major intraoperative complication was seen. Overall postoperative analgesic requirement was minimal. Cosmetic results were excellent at the initial postoperative visit. Conclusion: Retroperitoneoscopic nephroureterectomy by using three trocars is feasible and safe with excellent outcomes in pediatric patients with end-stage reflux nephropathy. Copyright 2010, Mary Ann Liebert, Inc