Prone retroperitoneoscopic approach for 30 Heminephroureterectomies; The Specific Advantages

Abstract

PURPOSE The lateral approach is more widely used in retroperitoneoscopic renal surgery due to familiar orientation and ease of conversion. We present a series of 30 heminephroureterectomies (HNU) where prone approach was utilised extremely effectively with no conversions and low complications. MATERIAL AND METHODS From November 2003 to October 2007, 31 HNU were performed. Thirty of these, done in prone position, were included in the study. Females constituted 57%. Mean age was 3.1 years (range 0.9-13.3, 60% under 2 years). The upper moieties were excised in 17 patients (9 ureterocels, 8 ectopic ureters) and lower moieties in 13 (10 reflux, 2 pelviureteric junction obstruction, 1 lower moiety stones). The video demonstrates the important steps and the specific advantages of this approach. Prospectively recorded data and notes were reviewed. Mean follow up was 19 months. RESULTS Mean operative duration was 141 min (range 100- 280 min). Drains were used in 50% for a mean of 2 days. Average post-operative stay was 1.7 days (range 0-6 days). One child, undergoing lower HNU, sustained ‘nipping’ of the upper moiety ureter with an endoloop causing incomplete obstruction. This was the 8th patient of the series. Residual ureteric stump was seen in 5; however, only one was symptomatic requiring excision of the stump and the ureterocele (this was the third patient of the series). There were no transfusions or conversions. Routine ultra sound showed healthy residual moieties in all. CONCLUSIONS With prone approach, the anatomy could be demonstrated quickly and clearly. The dissection could be done with ‘two-hands’ as the kidney is hanging down with no need for retraction. The whole length of the renal vessels could be seen, enabling accurate and meticulous control. The extent of ureteric dissection wasn't impaired and stump complications were minimal. Prone retroperitoneoscopic approach could be highly recommended for HNU.