Fluoroscopy-assisted retroperitoneal laparoscopic renal surgery in children

PURPOSE: To investigate the use of C-arm fluoroscopy for locating small dysplastic renal lesions during retroperitoneal laparoscopic nephrectomy in children. PATIENTS AND 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.