A Modified Access Technique for Retroperitoneoscopic Renal Surgery in Children
Bibliographic record
Abstract
PURPOSE: Present techniques for retroperitoneal endoscopic (RPE) access in children mimic those in adults but often result in peritoneal entry or gas leaks, both of which lead to a decrease in the retroperitoneal space. We describe a modification to the access technique that obviates these problems, thus, facilitating RPE in children. MATERIALS AND METHODS: In the lateral decubitus position the initial port is placed immediately lateral to the paraspinal muscles, similar to open dorsal lumbotomy fascial incision. A 5 mm skin incision is made at the level of the costovertebral angle and an artery forceps used to tunnel bluntly past the lumbodorsal fascia. A 5 mm port is placed with a blunt trocar, and expansion of the retroperitoneal space performed with the telescope and gas insufflation. Ancillary ports are placed and the telescope then moved to an anterior subcostal port where popular RPE approaches place the initial port. RESULTS: Eighteen procedures were performed in children with a mean age of 10.8 years, including 12 nephrectomies, 3 dismembered pyeloplasties, 1 partial nephrectomy, 1 nephroureterectomy and 1 parapelvic cyst decortication. No gas leaks occurred, with 1 minor peritoneal entry early in the series not related to the access. Average surgical time for nephrectomy was 178 minutes (range 120 to 240). No intraoperative complications occurred. CONCLUSIONS: We present a safe and effective technique of initial port placement that follows the principles of open lumbotomy exposure. This approach to RPE minimizes peritoneal entry and gas leaks, thus, maximizing surgical exposure.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.000 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.000 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".