Retroperitoneoscopic Nephrectomy For Hydronephrotic Kidney Due To Ureteropelvic Junction Obstruction With Stones

Retroperitoneoscopic nephrectomy is the ideal procedure for patients with poorly functioning, hugely dilated, or giant hydronephrotic kidneys due to stone disease, irrespective of patient age and type of renal anomaly (26).

In these cases, careful placement of the primary port is important so as to avoid puncturing the kidney. An initial 1.5 cm incision below and posterior to tip of the 12th rib is made and deepened down to the thoracolumbar fascia. Digital dissection or dissection with the help of Clutton's urethral dilator is done parallel to the dilated kidney to make space for placement of the balloon. The balloon itself may be placed within or outside Gerota's fascia as per the situation. The balloon should not be inflated over 400 to 500 mL. Retroperitoneal space can be created initially toward the upper pole, then toward the lower pole. Once the space is created, the kidney should be dissected first as the tense hydronephrotic sac helps in identification of the perirenal plane. With the distended renal sac keeping the renal parenchymal surface stretched, dissection can be performed with easy sweeping movements. After initial dissection, the kidney is deflated (often it gets punctured) and further dissection carried out after retracting the kidney anteriorly with a triflanged retractor. In these cases, usually renal vessels are attenuated and can be clipped with titanium clips or Hem-O-Lok plastic clips.

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