Laparoscopic (transperitoneal) nephrectomy is a well-established and versatile technique in pediatric practice [1, 2]. It allows surgery to be carried out by a minimally invasive approach in the familiar intraperitoneal compartment. It provides ample working space and has a short learning curve. It facilitates a one stop solution for anatomic variations, is helpful in complete excision of the ureter when needed (avoiding the need for multiple separate incisions) [1, 2], and it also allows the surgeon to manage other intraabdominal pathologies at the same time (e.g., inguinal hernia, undescended testis).

The patient is placed in lateral position, with pathologic side up, and at the edge of the table close to the operating surgeon. The laparoscopy stack and screen are on the other side of the operating table, facing the surgeon (Fig. 35.1).

A 5-mm trans-umbilical port is placed under direct vision by open cut down. A second 5-mm port is placed in the epigastric region midway between the xiphisternum and the umbilicus. The third 5-mm port is placed in the ipsilateral flank [2], maintaining the principle of triangulation (Fig. 35.2). The positions of the working ports have to be adjusted according to the size of patient, the size and position of the kidney, and the need for ureterectomy. The ports are secured in place with 3–0 suture to prevent dislodgement. Intra-abdominal pressure of 10–12 mmHg and a CO₂ flow rate of 2L/min are generally sufficient.