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CONGRESS OF THE ESPU
MATERIAL AND METHODS
Optical access technique was used for prone retroperitoneoscopic upper renal tract surgeries
and data was prospectively collected from June 2015 to March 2017. A 5 mm bladeless optical tip
trocar with zero degree short length telescope was used to access the retroperitoneum under direct
endoscopic vision with child in prone position. The trocar is advanced by rotating movement with
the telescope within it, visualising its passage through Latissimus dorsi, Serratus posterior inferior
muscles and thoracodorsal fascia. The retroperitoneal space is identified beyond the fascial layer
by presence of fat and fine radiating blood vessels. At this point CO2 is insufflated at 15 mmHg and
blunt dissection is carried out with the telescope tip to create the retroperitoneal working space and
then other ports are put under vison to complete the surgery.
RESULTS
20 renal surgeries (14-nephrectomies, 6-nephroureterectomy) were performed after gaining access
by this technique. Ages ranged from 3 months to 15 years, kidney sizes 1.6 to 15 cm. The average
time for access and establishing the retroperitoneal working space was 5-minutes (range 4–7).
Safe access was successfully achieved in all to complete the surgery successfully. A snug fit was
achieved at port sites avoiding the problems of gas leak or subcutaneous emphysema.
CONCLUSIONS
Retroperitoneal access could be achieved safely in a controlled manner, under vision and is repro-
ducible as shown in the video. Snug fit achieved at port sites, avoiding problems of gas leak and
air emphysema.