Horseshoe kidney: retroperitoneoscopic nephrectomy

Retroperitoneoscopic Nephrectomy in Pediatric Patients

Minimally invasive surgery (MIS) in pediatric population is becoming more and more popular among pediatric urologists and now it can be considered the best treatment for nephroureterectomy that is one of the most frequent urological procedures. The main indications to MIS ureteronephrectomy in children are congenital or acquired benign conditions such as nonfunctional and/or damaging kidney, renal dysplasia, and destroyed kidneys due to obstructive or refluxing uropathy. Since ever in open urological surgery, the lateral retroperitoneal approach represents the typical way to approach this kind of surgery. Although different surgical approaches can be chosen (i.e., posterior retroperitoneal, lateral retroperitoneal, laparoscopic transperitoneal, and robotic approach), the lateral retroperitoneal approach represents the typical way to perform this kind of surgery, also with minimally invasive techniques. In this article, we illustrate the technique of retroperitoneoscopic nephroureterectomy in infants and children, reporting our experience with this technique in the past 20 years.

Retroperitoneoscopic single-instrument horseshoe nephrectomy for dilated non-functioning right moiety

Retroperitoneoscopic horseshoe nephrectomy is an uncommon procedure, in particular in the paediatric practice. We present a procedure carried out via a posterior approach with a single working port in a 20 months old boy. The video goes through the technical aspect, from the positioning of the patient and the port insertion, to the end of procedure. Highlighted are the critical steps of directing the initial fascial dissection more caudal and medial compared to a standard approach for nephrectomy, as well as tips to safely ligate and divide the very short right renal vein. The operative time was 90 min. The postoperative course was uneventful. The retroperitoneal access provides a good visualisation of the hylum (including the IVC in case of right side approach), the ureter and the isthmus and has the advantage to preserve the abdominal cavity. The retroperitoneal approach is safe also in horseshoe kidney.