Comparison between closed and open techniques for creating a retroperitoneal space for retroperitoneoscopic renal surgery in children

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During retroperitoneoscopic renal surgery (RPRS), the open technique (OT) for trocar insertion is always associated with CO2 leakage around the first trocar, while the closed technique (CT) involves advancing an optical trocar into the retroperitoneal space (RS) under direct vision. We are the first to compare OT with CT.Forty-one cases of RPRS performed for pyeloplasty (31), hemi-nephrectomy (4), nephrectomy (4), stone removal (1), and cyst excision (1) were studied. The initial 5 mm trocar was inserted using OT (n = 11) or CT (n = 30). The tip of a telescope was used for blunt dissection of the retroperitoneum to create the RS.Ages and weights at RPRS were similar (OT versus CT: 7.3 versus 7.1 years; 25.4 versus 25.0 kg; respectively). In CT, RS access was significantly faster (38.2 versus 5.6 min), RS was created significantly quicker (77.7 versus 31.9 min), and narcotic usage was significantly less (4.0 versus 1.5 days). In OT, CO2 leaked in 11/11 and the retroperitoneum was torn in 3/11. In CT there was no leakage and no tearing.CT is quicker and safer than OT during RPRS.

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