Retroperitoneoscopic renal biopsy in children

Abstract

Objective: We present our experience in a series of 17 consecutive pediatric patients submitted to retroperitoneal laparoscopic renal biopsy. Materials and Methods: Retroperitoneal laparoscopic renal biopsy (LRB) was performed in 5 boys and 12 girls. Mean age was 8.1 years and age range from 2 to 12. Two or three trocars were used to expose the inferior pole of the kidney, remove enough cortical parenchymal specimen and fulgurate the biopsy site. Assessment included surgical time, estimated blood loss, hospitalization period, analgesia requirements, complications and number of glomeruli present in the specimen. Results: LRB was successfully performed in all 15 patients (88%). In two cases, LRB was not possible to be performed. One patient was converted to a transperitoneal laparoscopy due to tear in the peritoneum. The other patient had had previous abdominal surgery and, during retroperitoneal balloon dilation, the peritoneum was opened and the open biopsy was performed. A third patient had postoperatively a perirenal hematoma, which was solved spontaneously. Complication rate was 17.6% (3/17 cases). Mean operative time was 65 minutes, while mean estimated blood loss was 52 mL, mean hospital stay was 2.2 days and mean analgesic requirement was 100 mg of tramadol. The mean number of glomeruli present in the specimen was 60. Conclusion: Retroperitoneal laparoscopic renal biopsy in children is a simple, safe. Bleeding is still the most common complication. However, direct vision usually allows a safe control of this drawback. In our institution, laparoscopic approach is the chosen procedure in pediatric patients older than one -year -old.

Single-port retroperitoneal renal biopsy using standard urological instruments

“…Regarding the obtained samples, the average number of glomeruli present in the specimens was 31, and the histopathological findings showed focal proliferative lupus glomerulonephritis in two cases, diffuse mesangial proliferative glomerulonephritis in another two, and nephritis related to Henoch-Schönlein purpura in one child. These results are comparable to those previously shown by us, with laparoscopic renal biopsy in children, regarding operative time, blood loss, hospital stay and success in obtaining adequate samples ( 2 ).…”

“…At our institution, laparoscopic retroperitoneal renal biopsy is currently often performed for pediatric patients with nephrological conditions ( 2 ). As the surgical team’s experience progressed and the procedure was standardized, however, we felt that it should be even less invasive, especially for this very young population.…”

Nephrotic Syndrome and Idiopathic Membranous Nephropathy Associated with Autosomal-Dominant Polycystic Kidney Disease

“…The retroperitoneal endoscopic approach has gained popularity both worldwide and in our country, including indications in pediatric cases [21,22]. In fact, the retroperitoneoscopy or transperitoneal approach renal biopsy is now the preferred procedure for pediatric patients [23]. A new approach combining laparoscopy and percutaneous needle biopsy has been proposed [24].…”

Biopsia Renal Laparoscópica: ¿cuándo Utilizarla?

“…En Brasil, Jesus y cols, publica una serie de 17 pacientes, con edad promedio de 8,1 años (2-12), usando 2 a 3 trocares, describe un tiempo operatorio de 65 min, sangrado de 52 mL, corta estancia posquirúrgica y sin complicaciones mayores, reportando únicamente un hematoma perirrenal que se resolvió espontáneamente y dos rasgaduras del peritoneo 21 .…”