Bilateral synchronous posterior prone retroperitoneoscopic nephrectomy with simultaneous peritoneal dialysis: a new management for end-stage renal disease in children.

OBJECTIVE: To describe a laparoscopic approach for bilateral synchronous posterior prone retroperitoneoscopic nephrectomy (BSPPRN) which allows for immediate peritoneal dialysis (PD) in children with end-stage renal disease (ESRD), as PD is the treatment of choice in these children with ESRD who are awaiting renal transplantation. PATIENTS AND METHODS: Traditionally, children requiring bilateral native nephrectomy have been managed on haemodialysis before being converted to PD at a later stage, but this approach incorporates a conventional open transperitoneal nephrectomy, which had associated morbidity. Between May 2001 and December 2005, 20 children had BSPPRN with initiation or return to PD immediately afterward (mean age at surgery 8.5 years, range 0.5-17). The indications for surgery included steroid-resistant proteinuria in 14, drug-resistant hypertension in four, proteinuria and hypertension in one and intractable polyuria in one. BSPPRN used either three or two ports, or the 'single-instrument port' technique. A PD catheter was placed simultaneously in eight children, whilst 10 were already established on PD.
RESULTS: BSPPRN was successful in 19 children; one developed a peritoneal tear, which necessitated conversion to open nephrectomy. The mean (range) operative duration was 160 (110-180) min. There were no major complications and no child required a blood transfusion. PD was established immediately after surgery in 17 children; one had a dialysate leak requiring a period of haemodialysis.
CONCLUSION: In children who require bilateral native nephrectomy before renal transplantation, BSPPRN maintains the integrity of the peritoneal cavity, allowing for immediate PD after surgery. The technique is safe and has all the added advantages of minimally invasive surgery.