[Renal biopsy through a retroperitoneoscopic approach: our experience in 53 pediatric patients].
OBJECTIVE
The retroperitoneoscopic approach enables adequate vision of the renal fossa and retroperitoneal structures. Our objective is to support the performance of renal biopsies through a retroperitoneoscopic approach in those pediatric surgery departments still doing open biopsies.


METHODS
We performed 53 renal biopsies through a retroperitoneoscopic approach. Twenty-eight patients were males and 25 females, with ages between 13 months and 19 years (mean age range 4 years). The biopsies were indicated after the following diagnosis: nephrotic syndrome (n = 20), hemolytic-uremic syndrome (n = 3), hematuria (n = 15), idiopathic purpura (n = 2), proteinuria (n = 13). Ten patients were in renal failure. We performed our technique of retroperitoneoscopic approach in all cases.


RESULTS
Adequate exposure of the kidney was achieved in all cases, and the biopsy sample gave a pathologic diagnosis after immunohistochemical and morphologic studies. One case was converted to open surgery due to bleeding from the kidney. In 51 cases the estimated blood loss was lower than 20 cc. No drainage was necessary after surgery. Mean hospital stay was 48 hours for the first 20 cases and between 24-36 hours for the remainder.


CONCLUSIONS
The Retroperitoneoscopic renal biopsy is an adequate procedure for the pediatric patients and represents a real alternative to open biopsy, and in cases of contraindication for ultrasound guided percutaneous biopsy, because: 1. It offers an excellent exposure of the kidney. 2. It obtains a kidney sample enough for the study. 3. The morbidity associated with the procedure is minimal. 4. Diminishes the hospital stay and shortens the time to return back to normal life.
Luque Mialdea
Rafael
R
Servicio de Cirurgia Pediátrica Complejo Hospitalario de Toledo, España. rluque@sescam.jccm.es
Martín-Crespo Izquierdo
Rosa
R
Díaz
Luis
L
Fernández
Angustias
A
Morales
Dolores
D
Cebrían
Jesús
J
D000293:Adolescent; D000328:Adult; D001706:Biopsy / Q000379:methods; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007674:Kidney Diseases / Q000473:pathology*; D010535:Laparoscopy; D008297:Male