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[Laparoscopic nephrectomy in children: the transperitoneal vs the retroperitoneal approach].

OBJECTIVES
To evaluate the current state of laparoscopic nephrectomy in children. We compare the published techniques and results of the trans- and retro-peritoneal approaches.


METHODS
Literature search under "laparoscopic nephrectomy, children" in Medline, PubMed, American Academy of Pediatrics, Digital Urology Journal and, Doctor's Guide.


RESULTS
Laparoscopic surgery is well established in Pediatric Urology as evidenced by more than 330 reported procedures on the subject of simple nephrectomy, partial nephrectomy, bilateral nephrectomy, nephrectomy for horseshoe kidney and, nephro-ureterectomy. Retro-peritoneoscopic nephrectomy was described later than the trans-peritoneal procedure but seems to have gained more popularity since more cases have been reported. Mean operative time for transperitoneal approach is 126 minutes (range 40-355 minutes), and for retro-peritoneoscopic approach is 85 minutes (range 35-210 minutes). Median blood loss for both approaches for simple nephrectomy is 30 ml (range 5-150 ml). Median hospitalization time for either approach is 2 days (range < 1-4 days).


CONCLUSIONS
Pediatric laparoscopic nephrectomy is supported by low morbidity and rapid recuperation, creating an increasing demand for the procedure. The main disadvantage seems to be a longer operative time, but in recent series the times are improving. The retro-peritoneoscopic approach seems to be gaining momentum as more and more case are reported.