Retroperitoneoscopic Nephroureterectomy viaThree Trocars in Pediatric Patients with End-Stage Reflux Nephropathy.

AbstractBackground 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 (75–230 min). 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. [ABSTRACT FROM AUTHOR]