title: Experience with retroperitoneoscopy in pediatric surgical oncology.
abstract: BACKGROUND
  Retroperitoneoscopy (RS) has been successfully introduced in adult oncology for diagnostic procedures, staging, and surgical treatment. Its value for children has rarely been reported. This report describes the authors' experience using RS in the diagnosis and staging of cancer for children and adolescents.
  
  
  METHODS
  All RS procedures performed at the authors' institution between 2004 and 2010 were reviewed. The authors' operative technique entails a 10- to 12-mm flank incision followed by finger and balloon dissection of the retroperitoneal areolar tissue, with carbon dioxide (CO(2)) insufflation used to push the peritoneal lining medially. One to two additional working ports are placed above the iliac rim and below the costal margin. In cases of peritoneal tear with leakage of CO(2) and progressive retroperitoneal impingement, a Veress needle is placed in the umbilicus for pressure release.
  
  
  RESULTS
  This review included 16 patients with a median age of 16.4 years (range, 4.4-29.8 years) who underwent RS for lymph node sampling (9 cases), diagnostic biopsy (6 cases), or resection of a metastatic nodule (1 case). Four complications were encountered (3 conversions to open surgery and 1 self-limited gross hematuria). The mean operative time was 123.3 ± 33.5 min. The patients required 1.1 ± 0.8 days of intravenous analgesia on the average. The mean hospital stay was 1.7 ± 0.6 days.
  
  
  CONCLUSIONS
  The authors believe that RS is a safe surgical technique for access to the retroperitoneum in pediatric patients. In cases of a peritoneal tear, placement of a Veress needle in the umbilicus effectively prevents conversion to open surgery. Retroperitoneoscopy should be considered for children who need biopsies, lymph node dissections, or resections of primary tumors in the retroperitoneum.
authors.affiliation: Pediatric Surgical Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA.
authors.forename: Till M
authors.initials: TM
authors.lastname: Theilen
authors.forename: Thambipillai Sri
authors.initials: TS
authors.lastname: Paran
authors.forename: Daniel
authors.initials: D
authors.lastname: Rutigliano
authors.forename: Leonard
authors.initials: L
authors.lastname: Wexler
authors.forename: Yukio
authors.initials: Y
authors.lastname: Sonoda
authors.forename: Michael P
authors.initials: MP
authors.lastname: LaQuaglia
mesh_terms: D000008:Abdominal Neoplasms / Q000175:diagnosis* / Q000601:surgery*; D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D010535:Laparoscopy; D008297:Male; D012187:Retroperitoneal Space; D012189:Retrospective Studies; D055815:Young Adult