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Surgical Endoscopy

, Volume 25, Issue 8, pp 2748–2755 | Cite as

Experience with retroperitoneoscopy in pediatric surgical oncology

  • Till M. Theilen
  • Thambipillai Sri Paran
  • Daniel Rutigliano
  • Leonard Wexler
  • Yukio Sonoda
  • Michael P. LaQuaglia
Technique

Abstract

Background

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.

Methods

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.

Results

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.

Conclusions

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.

Keywords

Childhood Lymph node dissection Paratesticular Retroperitoneal laparoscopy Retroperitoneoscopy Rhabdomyosarcoma 

Notes

Disclosures

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.

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Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  • Till M. Theilen
    • 1
  • Thambipillai Sri Paran
    • 1
  • Daniel Rutigliano
    • 1
  • Leonard Wexler
    • 2
  • Yukio Sonoda
    • 3
  • Michael P. LaQuaglia
    • 1
  1. 1.Pediatric Surgical Service, Department of SurgeryMemorial Sloan-Kettering Cancer CenterNew YorkUSA
  2. 2.Department of PediatricsMemorial Sloan-Kettering Cancer CenterNew YorkUSA
  3. 3.Gynecology Service, Department of SurgeryMemorial Sloan-Kettering Cancer CenterNew YorkUSA

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