RETROPERITONEOSCOPIC RENAL BIOPSY

Objective: Present the advantages and difficulties to access the retroperitoneum for laparoscopic renal biopsies. Material and Methods: We analyzed thirty patients with percutaneous biopsy contraindication (coagulopathy, anatomic alteration, and failure in the percutaneous procedure) who were submitted to laparoscopic renal biopsy. The access was made by a 10-mm incision in the extremity of the 12th rib and muscle dissection until the retroperitoneum. The modified Gaur balloon was allocated into the retroperitoneum and filled with 500 to 800 ml of saline. One or 2 additional 5-mm ports were made in order to perform the biopsy. Results: The main difficulty in the retroperitoneoscopy was the limited working space, and sometimes it was difficult to manipulate the instruments. The conversion occurred in only one patient, due to problems to visualize the kidney. The rupture of the Gaur balloon occurred in 2 cases, without additional lesions. Peritoneum perforation occurred in 3 cases, without need of conversion. Mean surgical time was 40 minutes. Conclusion: The retroperitoneoscopic renal biopsy is a procedure with low complication rates. The advantages are the easy access to the kidney and the adequate removal of material for analysis. The main disadvantage is the limited working space