Fluoroscopy-assisted retroperitoneal laparoscopic renal surgery in children.
OBJECTIVE
To investigate the use of C-arm fluoroscopy for locating small dysplastic renal lesions during retroperitoneal laparoscopic nephrectomy in children.


METHODS
From March 2003 to March 2005, two boys and four girls with a mean age of 5 years underwent retroperitoneal laparoscopic nephrectomy under C-arm fluoroscopic guidance. The indications for laparoscopic renal surgery were ectopic ureter with dysplastic kidney (N = 3), hypertensive nephropathy (N = 1), and dysplastic kidney secondary to reflux nephropathy (N = 2).


RESULTS
All operations were completed with no necessity for conversion to open surgery. Small dysplastic kidneys were easily located using C-arm fluoroscopy, and retroperitoneal laparoscopic nephrectomy was then performed. One patient required open contralateral reimplantation after laparoscopic nephrectomy because of high-grade vesicoureteral reflux. The mean operative time was 139 minutes (range 71-210 minutes). Blood loss was minimal, and no transfusion was required. There were no intraoperative or postoperative complications other than a peritoneal injury in one patient, which caused no subsequent major problem. The mean postoperative hospital stay was 3.8 days, and all children returned to normal activity within 3 to 6 days.


CONCLUSIONS
This is the first report to our knowledge of retroperitoneal laparoscopic renal surgery under C-arm fluoroscopic guidance. This approach allowed quick and easy location of small ectopic kidneys prior to retroperitoneal laparoscopic nephrectomy and was found to be very useful for the treatment of small dysplastic renal lesions in children.
Song
Seung-Hun
SH
Department of Urology, CHA General Hospital, Seoul, Korea.
Lee
Sang Bok
SB
Yoo
Dal San
DS
Kim
Kun Suk
KS
D002648:Child; D002675:Child, Preschool; D005260:Female; D005471:Fluoroscopy; D006801:Humans; D006977:Hypertension, Renal / Q000150:complications; D007223:Infant; D007668:Kidney / Q000002:abnormalities / Q000000981:diagnostic imaging; D007674:Kidney Diseases / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D009392:Nephrectomy / Q000295:instrumentation* / Q000379:methods*; D012187:Retroperitoneal Space / Q000601:surgery; D016896:Treatment Outcome; D014513:Ureter / Q000002:abnormalities / Q000000981:diagnostic imaging; D014718:Vesico-Ureteral Reflux / Q000150:complications