Wilms tumor is the most common pediatric renal malignancy. Surgical resection is an important aspect of therapy and is generally performed through an open transabdominal approach. The advent of advanced laparoscopic techniques for benign renal disease has led to interest in applying a minimally invasive approach to renal tumors in children.

We describe a 2 year old girl who presented with an 18 x 13 cm right renal mass with intraabdominal and pulmonary metastatic disease. Wilms tumor was confirmed on transperitoneal biopsy. After neoadjuvant chemotherapy, a laparoscopic resection of the tumor with right radical nephroureterectomy and retroperitoneal lymph node dissection was performed.

The procedure required four 5 mm ports and one 12 mm port for stapling of the renal hilar vessels. The procedure was performed entirely via laparoscopic approach including resection of the kidney and tumor, dissection of the tumor from the liver, sampling of retroperitoneal lymph nodes, and removal of peritoneal implants from the abdomen. The 12 mm port site was extended into a Pfannenstiel incision to remove the mass in a retrieval bag. The patient had an uncomplicated recovery and was discharged on postoperative day five. Surveillance imaging at six weeks following resection revealed no abdominal or pelvic disease.

Laparoscopic resection of Wilms tumor is safe and feasible in the setting of known metastatic disease. A video will demonstrate salient points of the procedure with special attention to application of oncologic principles. The authors will discuss specific indications for the laparoscopic approach to resection of Wilms tumor.