There is not uniform agreement on the evaluation of bilateral Wilm's Tumor. The National Wilm's Tumor Study has stated that bilateral Wilm's Tumor is a stage V and that each tumor should be staged separately. With this in mind, when a 2 year old female presented with the presumptive diagnosis of bilateral Wilm's Tumor, the approach to staging involved CT scanning and a minimally invasive approach to evaluating each tumor separately, including biopsy.

CT revealed that the left renal tumor was much larger than the right and that there was minimal preserved renal parenchyma. The right sided tumor was smaller and than left. The remaining renal parenchyma was greater than that on the left. Had this been a unilateral Wilm's, that side would have been excised but as the remaining renal tissue was no greater than 10% of normal, it was elected to biopsy each tumor via the laparoscope. It is the intention of those involved, to operate 6 weeks after the start of chemotherapy.

The video will demonstrate the approach to the biopsy of these tumors as well as the CT of the lesions.