1. La laparoscopia nella patologia delle vie urinarie
Università degli Studi di Napoli “Federico II”
Dipartimento di Pediatria
Cattedra di Chirurgia Pediatrica
Direttore: Prof. Alessandro Settimi
La laparoscopia nella patologia delle vie urinarie

2. In the last years ,renal pathologies are also beginning to be dealt with using laparoscopic procedures
Urological videosurgical procedures
represent only 5-10% of all
videosurgical interventions

3. Two routes are usually used
transperitoneal
retroperitoneal

4. The TRANSPERITONEAL route is easier, because it allows the surgeon to work in a wider cavity as the more familiar peritoneal chamber

5. The RETROPERITONEAL route can be more difficult due to the small operating chamber
It meets all the criteria of open renal surgery

6. INDICATIONS Nephrectomy Heminephrectomy Renal cyst resection
Stone removal
Ureterocutaneostomy
Adrenalectomy
Renal biopsies

7. LAPAROSCOPIC UROLOGY TROCARS 5-mm Retractor 10-mm Optic 5-mm 10-mm
1st operative
5-mm
2nd operative

8. LAPAROSCOPY
TRANSPERITONEAL
ROUTE

9. RETROPERITONEOSCOPY

10. RETROPERITONEOSCOPY

11. PATIENT SET-UP

12. RETROPERITONEAL CHAMBER
Posterior axillary line
Between 12th rib
and iliac crest

13. BALOON DISSECTION

14. OPTIC DISSECTION
DIGITAL DISSECTION

15. RETROPERITONEOSCOPY TROCARS
10-mm
Optic
5-mm
2 nd operative
5-mm
1st operative
5-mm

16. BALLOON TROCAR

17. RETROPERITONEAL NEPHRECTOMY
Patient in a lateral decubitus
3 trocars
Retroperitoneal chamber, balloon trocar
Kidney and ureter isolated
Vessels sectioned between clips or ligatures
Kidney removed through optique orifice

18. WORKING SPACE

19. KIDNEY

20. URETER

21. HILAR VESSELS

22. ADRENALECTOMY
The adrenal tumors in children are often large , malignant and infiltrative
Very few experiences have been reported
Experience of each team is limited to less than 4 cases

23. ADRENALECTOMY #2 Indications
Benign lesions ( Adenoma, hyperplasy, cysts)
Selected cases of malignant tumors
Size < 6 cm in adolescents and < 3 cm neonates
No age limits

24. ADRENALECTOMY

25. RESULTS Laparoscopy: adhesions, infection
Operating time: minutes (70mns)
Laparoscopy: adhesions, infection
Lomboscopy: peritoneal perforation

26. CONSIDERATIONS More direct and fast Less trocars
Avoid problems of adhesions due to previous abdominal surgery
Limited working space
Needs habit and skills
Could be a disadvantage in case of complications

27. LEGAL ASPECTS - Informated Consensus - Before each procedure
- Both the parents

28. CONCLUSIONS
The retroperitoneal route is preferable when approaching renal pathologies as in traditional open surgery
Laparoscopic transperitoneal experience necessary