Backward kidney surgery: The new gold standard?

By Christine Zeindler

Going behind the patient’s back may be best way to remove their kidneys, according to pediatric surgeon Dr. J.P. Capolicchio at the Montreal Children’s Hospital of the McGill University Health Centre. He and his Urology Department colleagues have perfected a new minimally invasive technique to reach the kidney by entering through the patient’s back, rather than wading through the abdominal cavity.

 

“Removing kidneys from the back by a procedure called retroperitoneoscopic nephrectomy, is the solution for children who are already receiving a specific type of dialysis,” says Dr. Capolicchio. “This surgery is minimally invasive, has less complications than open surgery and the recovery time is faster.”

 

Young and old patients with chronic kidney failure require dialysis to compensate for the loss of kidney function. They can either undergo hemodialysis, where the blood is filtered using an external machine or peritoneal dialysis, which involves using the abdominal lining as a filter. Peritoneal dialysis is the preferred choice because this procedure can be done at home while children are sleeping, rather than in the hospital. “Children and their families are not hostages of the hospital with peritoneal dialysis,” says Dr. Capolicchio.

 

The downside of abdominal entry for removing kidneys is that peritoneal dialysis then becomes impossible. However, peritoneal dialysis can continue if a retroperitoneal laparoscopic nephrectomy is preformed.

 

Dr. Capolicchio and his team have successfully removed kidneys from 17 patients on peritoneal dialysis so far. “This may not seem like a large number, but we are second only to London, England.”

 

In a few rare cases removal of a tiny organ, the adrenal gland, which sits on top of the kidney, is necessary. Until now, this too has been accomplished by going through the abdominal cavity. Dr. Capolicchio and his team have recently removed these glands going through the back in a procedure called anterior retroperitoneoscopic adrenalectomy. So far, they have completed this surgery three times.

 

Dr. Capolicchio and his team are the second group worldwide to publish their experience with both these procedures.