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      Single-port retroperitoneal renal biopsy using standard urological instruments

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          Abstract

          Objective

          To describe the surgical technique and initial experience with a single-port retroperitoneal renal biopsy (SPRRB).

          Materials and Methods

          Between January and April 2013, five children underwent SPRRB in our hospital. A single 1.5 cm incision was performed under the 12th rib at mid-axillary line, and an 11 mm trocar was inserted. A nephroscope was used to identify the kidney and dissect the perirenal fat. After lower pole exposure, a laparoscopic biopsy forceps was introduced through the nephroscope working channel to collect a renal tissue sample.

          Results

          SPRRB was successfully performed in five children. The mean operative time was 32 minutes, and mean estimated blood loss was less than 10 mL. The hospital stay of all patients was two days because they were discharged in the second postoperative day, after remaining at strict bed rest for 24 hours after the procedure. The average number of glomeruli present in the specimen was 31.

          Conclusion

          SPRRB is a simple, safe and reliable alternative to open and videolaparoscopic approaches to surgical renal biopsy.

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          Most cited references10

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          Imaging-guided percutaneous renal biopsy: rationale and approach.

          The purpose of this article is to discuss the history of, indications and rationale for, and approach to imaging-guided percutaneous renal biopsies. With the progressive increase in the number of incidentally discovered renal masses, increased use of percutaneous ablation as a treatment alternative for the management of renal cell carcinoma and improvements in immunohistochemistry techniques, imaging-guided renal biopsy will continue to serve as a useful tool for the evaluation and management of renal diseases.
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            One-trocar surgery: a less invasive videosurgical approach in childhood.

            Laparoscopic techniques and instruments are evolving to lessen the invasiveness of this surgical approach. The authors present their experience with the videosurgical approach using only 1 trocar. Between October 1997 and January 2000 the authors performed 59 videosurgical procedures using a 1-trocar approach (mean age, 11.5 years; range, 4 to 18 years). A 10-mm Hasson trocar was inserted in an "open" fashion either through the umbilicus (laparoscopy) or below the apex of the 12th rib (retroperitoneoscopy). An operative laparoscope was used in all cases. The operations were 18 retroperitoneoscopic Palomo varicocelectomies, 1 retroperitoneoscopic renal biopsy, 38 appendectomies, and 2 ileal resections (Meckel's diverticulum, duplication cyst). For appendectomies and ileal resections, the corresponding intestinal loop was grasped and exteriorized through the umbilicus to perform conventional surgery. Mean operating time was 50.9 minutes (range, 30 to 120) for laparoscopies and 44 minutes (range, 15 to 80) for retroperitoneoscopy. There were 11 conversions (8 appendectomies, 3 varicocelectomies) and no postoperative complications. "One-trocar surgery" is safe, effective, and fast with a low complication rate and excellent cosmetic results. The authors believe it is the least invasive as well as the most effective approach in the treatment of varicocele, appendicitis, and selected intestinal diseases. Copyright 2001 by W.B. Saunders Company.
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              [Renal biopsy through a retroperitoneoscopic approach: our experience in 53 pediatric patients].

              The retroperitoneoscopic approach enables adequate vision of the renal fossa and retroperitoneal structures. Our objective is to support the performance of renal biopsies through a retroperitoneoscopic approach in those pediatric surgery departments still doing open biopsies.
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                Author and article information

                Journal
                Int Braz J Urol
                Int Braz J Urol
                International Brazilian Journal of Urology : official journal of the Brazilian Society of Urology
                Sociedade Brasileira de Urologia
                1677-5538
                1677-6119
                Jan-Feb 2015
                Jan-Feb 2015
                : 41
                : 1
                : 168-171
                Affiliations
                [1 ]Department of Urology, Medical School, São Paulo State University (UNESP), Botucatu, SP, Brazil
                Author notes
                Correspondence address: Rodrigo Guerra, MD. Department of Urology, School of Medicine. São Paulo State University (UNESP). Campus de Rubião Júnior. Botucatu, SP, 18.618-970, Brazil. Fax: + 55 14 3880-1568. E-mail: rodrigo.guerra@ 123456fmb.unesp.br

                CONFLICT OF INTEREST

                None declared.

                Article
                S1677-5538.IBJU.2015.01.22
                10.1590/S1677-5538.IBJU.2015.01.22
                4752070
                25928523
                c3f2407c-a0a3-4481-b3c0-12ceb11ff562

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 09 February 2014
                : 13 May 2014
                Page count
                Figures: 3, Tables: 1, Equations: 0, References: 5, Pages: 4
                Categories
                Surgical Technique

                kidney,biopsy,retroperitoneal space,surgical procedures,operative,minimally invasive surgical procedures,laparoscopy

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