Retroperitoneoscopic renal surgery is performed by lateral or posterior approaches. Iterative modification led to development of an alternative 'anterior' approach. The study authors' experience with this novel approach in a prospective series of 69 children that includes 17 infants is reported. Mean operating time was 225 min for reduction pyeloplasty. Peritoneal tear is not uncommon (22%) but often does not require conversion. In the study authors' early experience, the conversion rate was 17% and postoperative complications 2.9%. This approach overcomes many existing challenges with retroperitoneoscopy. Benefits of exposure, orientation, and working space achieved with a transperitoneal approach are afforded while preserving the advantages of retroperitoneoscopy.
