Experience with retroperitoneoscopy in pediatric surgical oncology
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Retroperitoneoscopy (RS) has been successfully introduced in adult oncology for diagnostic procedures, staging, and surgical treatment. Its value for children has rarely been reported. This report describes the authors’ experience using RS in the diagnosis and staging of cancer for children and adolescents.
All RS procedures performed at the authors’ institution between 2004 and 2010 were reviewed. The authors’ operative technique entails a 10- to 12-mm flank incision followed by finger and balloon dissection of the retroperitoneal areolar tissue, with carbon dioxide (CO2) insufflation used to push the peritoneal lining medially. One to two additional working ports are placed above the iliac rim and below the costal margin. In cases of peritoneal tear with leakage of CO2 and progressive retroperitoneal impingement, a Veress needle is placed in the umbilicus for pressure release.
This review included 16 patients with a median age of 16.4 years (range, 4.4–29.8 years) who underwent RS for lymph node sampling (9 cases), diagnostic biopsy (6 cases), or resection of a metastatic nodule (1 case). Four complications were encountered (3 conversions to open surgery and 1 self-limited gross hematuria). The mean operative time was 123.3 ± 33.5 min. The patients required 1.1 ± 0.8 days of intravenous analgesia on the average. The mean hospital stay was 1.7 ± 0.6 days.
The authors believe that RS is a safe surgical technique for access to the retroperitoneum in pediatric patients. In cases of a peritoneal tear, placement of a Veress needle in the umbilicus effectively prevents conversion to open surgery. Retroperitoneoscopy should be considered for children who need biopsies, lymph node dissections, or resections of primary tumors in the retroperitoneum.
KeywordsChildhood Lymph node dissection Paratesticular Retroperitoneal laparoscopy Retroperitoneoscopy Rhabdomyosarcoma
Michael P. LaQuaglia, Yukio Sonoda, Till M. Theilen, Thambipillai Sri Paran, Daniel Rutigliano, and Leonard Wexler have no conflicts of interest or financial ties to disclose.
- 8.LeBlanc E, Caty A, Dargent D, Querleu D, Mazeman E (2001) Extraperitoneal laparoscopic para-aortic lymph node dissection for early stage nonseminomatous germ cell tumors of the testis with introduction of a nerve-sparing technique: description and results. J Urol 165:89–92PubMedCrossRefGoogle Scholar
- 16.Pampaloni E, Valeri A, Mattei R, Presenti L, Centonze N, Neri AS, Salti R, Noccioli B, Messineo A (2004) Initial experience with laparoscopic adrenal surgery in children: is endoscopic surgery recommended and safe for the treatment of adrenocortical neoplasms? Pediatr Med Chir 26:450–459PubMedGoogle Scholar
- 20.Wickham JA (1979) The surgical treatment of renal lithiasis. Churchill Livingston, New YorkGoogle Scholar
- 31.Occelli B, Narducci F, Lanvin D, Querleu D, Coste E, Castelain B, Gibon D, LeBlanc E (2000) De novo adhesions with extraperitoneal endosurgical para-aortic lymphadenectomy versus transperitoneal laparoscopic para-aortic lymphadenectomy: a randomized experimental study. Am J Obstet Gynecol 183:529–533PubMedCrossRefGoogle Scholar
- 32.Fowler JM, Hartenbach EM, Reynolds HT, Borner J, Carter JR, Carlson JW, Twiggs LB, Carson LF (1994) Pelvic adhesion formation after pelvic lymphadenectomy: comparison between transperitoneal laparoscopy and extraperitoneal laparotomy in a porcine model. Gynecol Oncol 55:25–28PubMedCrossRefGoogle Scholar
- 37.Gil-Moreno A, Franco-Camps S, Diaz-Feijoo B, Perez-Benavente A, Martinez-Palones JM, Del Campo JM, Parera M, Verges R, Castellvi J, Xercavins J (2008) Usefulness of extraperitoneal laparoscopic para-aortic lymphadenectomy for lymph node recurrence in gynecologic malignancy. Acta Obstet Gynecol Scand 87:723–730PubMedCrossRefGoogle Scholar