1
|
Zhang YH, Chen ZL, Shi L, Chen ZJ, Dong XY, Zhai B. Diagnosis and treatment of postoperative intestinal perforation in infants and young children with congenital heart disease: A report of three cases. Exp Ther Med 2018; 15:4498-4502. [PMID: 29731834 DOI: 10.3892/etm.2018.5963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Accepted: 10/04/2016] [Indexed: 11/06/2022] Open
Abstract
The aim of the present study was to analyze risk factors of intestinal perforation following surgery for the treatment of congenital heart disease in infants and young children, and to summarize experiences of diagnosis and treatment. A total of 3,270 children, who underwent congenital heart disease surgery under extracorporeal circulation from January 2010 to July 2015, were retrospectively analyzed. Among these children, three (0.09%) developed postoperative intestinal perforation. Primary diseases were Tetralogy of Fallot (two cases) and ventricular septal defect combined with atrial septal defect (one case). The age range of the children was 6-11 months and the weight range was 7.3-8.6 kg. Furthermore, these children underwent radical surgery under general anesthesia and extracorporeal circulation in low temperatures. Abdominal symptoms appeared 4-10 days after surgery, and included poor appetite, abdominal distension, intermittent vomiting, high fever, refractory irritability, crying and shortness of breath. One case was confirmed by routine abdominal puncture and the remaining two were confirmed by the detection of free gas under the diaphragm, as revealed by abdominal X-ray. Following the diagnosis of intestinal perforation, emergency intestinal fistula surgery was performed. At 3-5 days post-surgery, the patients underwent treatment by fasting and intravenously administered parenteral nutrition. Diet was increased following recovery of bowel function. All patients recovered following active treatment and 3-4 months following hospital discharge, the fistula was successfully closed. In conclusion, a concerted effort should be made to identify intestinal perforation in infants and young children with postoperative congenital heart disease during emergency surgery. Early diagnosis and treatment may significantly improve prognosis and reduce mortality.
Collapse
Affiliation(s)
- Yong-Hong Zhang
- Department of Cardiothoracic Surgery, Children's Hospital of Zhengzhou City, Zhengzhou, Henan 450052, P.R. China
| | - Zhen-Liang Chen
- Department of Cardiothoracic Surgery, Children's Hospital of Zhengzhou City, Zhengzhou, Henan 450052, P.R. China
| | - Lei Shi
- Department of Cardiothoracic Surgery, Children's Hospital of Zhengzhou City, Zhengzhou, Henan 450052, P.R. China
| | - Zhong-Jian Chen
- Department of Cardiothoracic Surgery, Children's Hospital of Zhengzhou City, Zhengzhou, Henan 450052, P.R. China
| | - Xiang-Yang Dong
- Department of Cardiothoracic Surgery, Children's Hospital of Zhengzhou City, Zhengzhou, Henan 450052, P.R. China
| | - Bo Zhai
- Department of Cardiothoracic Surgery, Children's Hospital of Zhengzhou City, Zhengzhou, Henan 450052, P.R. China
| |
Collapse
|
2
|
Transumbilical multi-port laparoscopic pyeloplasty versus transumbilical single-site laparoscopic pyeloplasty for ureteropelvic junction obstruction in children: A retrospectively comparative study. J Pediatr Urol 2017. [PMID: 28630020 DOI: 10.1016/j.jpurol.2017.05.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
INTRODUCTION Laparoscopic pyeloplasty has achieved good cosmetic and functional outcomes. Both transumbilical single-site and transumbilical multi-port approaches are currently being used. No comparison of transumbilical single-site laparoscopic pyeloplasty (TSLP) and transumbilical multi-port laparoscopic pyeloplasty (TMLP) has been reported in the literature. OBJECTIVES We present a retrospective comparison study to evaluate clinical outcomes of TSLP and TMLP for children with ureteropelvic junction obstruction (UPJO). STUDY DESIGN A retrospective study was carried out comparing TSLP and TMLP performed by a single surgeon between July 2012 and June 2014. The patient data of the two groups (90 in each group) were evaluated. All patients underwent urine analysis, ultrasonography, magnetic resonance urography, and diuretic renogram using 99Tc-diethylene triamine pentaacetic acid scan preoperative and postoperative follow-up. Data were analyzed using the SPSS 20.0 software package. RESULTS DISCUSSION: To our knowledge, our series is the first report in the literature that compares the outcomes of TSLP and TMLP in children. Our study suggested that there were no significant differences in start of oral feeding, drain removal, hospital stay, postoperative renal pelvic anteroposterior diameter and differential renal function at 6 months, postoperative complications, and success rate between the two groups. It demonstrated that TMLP is as effective and safe as TSLP. Although the cosmetic result of the TSLP group is satisfactory, TMLP requires three 0.5-cm ports around the umbilicus and does not change the shape of the umbilicus. Hence, the cosmetic result of the TMLP group is better than that of the TSLP group. TSLP involves some technical challenges. However, TMLP facilitates the procedure and renders the operation easier. Our findings confirmed that the operative time of TMLP group is shorter than that in TSLP group, and also showed that TMLP is relatively easy to perform compared with TSLP. CONCLUSION TMLP is a feasible and safe operation for pediatric UPJO. TMLP is shorter in operative time and has a better cosmetic result than TSLP. We propose TMLP as a more viable treatment option for pediatric UPJO.
Collapse
|
3
|
Liu D, Zhou H, Chao M, Qi J, Wei H, An N, Chen H, Li L. Transumbilical Single-Site Multiport Laparoscopic Pyeloplasty for Children with Ureteropelvic Junction Obstruction in China: A Multicenter Study. J Laparoendosc Adv Surg Tech A 2017; 27:655-659. [PMID: 28350215 DOI: 10.1089/lap.2016.0306] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Transumbilical single-site multiport laparoscopic pyeloplasty (TSMLP) for children with ureteropelvic junction obstruction (UPJO) has become feasible and popular recently. The purpose of this study was to evaluate the safety and efficacy of TSMLP for pediatric UPJO in a large multicenter series. MATERIALS AND METHODS Medical records of consecutive patients who underwent TSMLP for pediatric UPJO in six academic institutions between June 2010 and May 2015 were retrospectively analyzed. The data of ultrasound, magnetic resonance urography, and diuretic renogram using 99Tc-diethylene triamine pentaacetic acid scan were collected during preoperative and postoperative periods. RESULTS A total of 704 patients (750 kidneys) with UPJO who underwent TSMLP were recruited for this study. Of these patients, there were no significant differences in demographics and clinical presentation of the patients among the six centers. The operative time of all patients decreased significantly with time. The earlier the beginning of the operation, such as cohort A, B, and C, the longer the learning curve has been. Of these 704 patients, there were 60 (8.11%) postoperative minor complications during the postoperative hospitalization period, and all minor postoperative complications were cured by observation or drugs. There were 14 (1.99%) major postoperative complications, and all major complications were cured by minimally invasive surgery. No additional complications were encountered during the follow-up of 2.1 years (mean, ranged 1 year to 4 years). Success rate of TSMLP are more than 95% among six centers. CONCLUSIONS We reported a multi-institutional series of TSMLP in children with UPJO. Our findings suggest that TSMLP represents a feasible treatment option for UPJO by offering reliable outcomes, low postoperative complications and high success rates.
Collapse
Affiliation(s)
- Dehong Liu
- 1 Department of Pediatric Urology, Bayi Children's Hospital, Affiliated to Chinese PLA Army General Hospital , Beijing, People's Republic of China
| | - Huixia Zhou
- 1 Department of Pediatric Urology, Bayi Children's Hospital, Affiliated to Chinese PLA Army General Hospital , Beijing, People's Republic of China
| | - Min Chao
- 2 Department of Pediatric Urology, Anhui Provincial Children's Hospital , Hefei, People's Republic of China
| | - Jinchun Qi
- 3 Department of Urology, The Second Hospital of Hebei Medical University , Shijiazhuang, People's Republic of China
| | - Huayu Wei
- 4 Department of Urology, The People's Hospital of Guangxi Zhuang Autonomous Region , Nanning, People's Republic of China
| | - Nini An
- 5 Department of Pediatric Surgery, Guizhou Provincial People's Hospital , Guiyang, People's Republic of China
| | - Haitao Chen
- 6 Department of Pediatric Urology, Hubei Provincial Maternal and Child Healthcare Hospital , Wuhan, People's Republic of China
| | - Long Li
- 7 Department of Pediatric Surgery, The Capital Institute of Pediatrics , Beijing, People's Republic of China
| |
Collapse
|
4
|
A modified technique of paraumbilical three-port laparoscopic dismembered pyeloplasty for infants and children. Pediatr Surg Int 2016; 32:1037-1045. [PMID: 27567622 DOI: 10.1007/s00383-016-3958-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/22/2016] [Indexed: 01/16/2023]
Abstract
BACKGROUND Common causes of complications of laparoscopic pyeloplasty in children include anastomotic stricture, poor drainage due to high ureteropelvic anastomosis, and torsion of ureter. Herewith, we described our modified technique of paraumbilical three-port laparoscopic dismembered pyeloplasty (PTLDP) to minimize these complications. PATIENTS AND METHODS Data from 62 patients (age: 1-180 months, median: 12 months) with ureteropelvic junction obstruction (UPJO) who underwent pyeloplasty using our modified technique of PTLDP between February 2014 and September 2014 at our institution were reviewed. The key steps of our modified method involve identifying the lowest point of the renal pelvis and the lateral aspect of the ureter to guarantee a low pelviureteric and correct orientation anastomosis, and using a 4-0 silk for assistant suturing to avoid crushing of the anastomotic tissue. RESULTS All surgeries were successfully completed without conversion. Three patients required an accessory port for the anastomosis. All the patients achieved complete clinical or radiologic resolution after the operation. The mean operative time was 103.4 min, and mean estimated blood loss was 14.4 mL. Mean postoperative differential function of affected kidney was 43.0 ± 16.3 % (range 24-100 %), increased from 39.7 ± 18.0 % (range 18-100 %), preoperatively (p < 0.001). The success rate was 100 % at a mean follow-up of 18.3 ± 2.9 (range 13-25) months. CONCLUSIONS Our modified technique of PTLDP is safe and feasible and to allow high success rate for the treatment of pelviureteric junction obstruction in children.
Collapse
|
5
|
Liu D, Zhou H, Ma L, Zhou X, Cao H, Tao T, Luo X, Chen S. Comparison of Laparoscopic Approaches for Dismembered Pyeloplasty in Children With Ureteropelvic Junction Obstruction: Critical Analysis of 11-Year Experiences in a Single Surgeon. Urology 2016; 101:50-55. [PMID: 27765585 DOI: 10.1016/j.urology.2016.10.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Revised: 09/29/2016] [Accepted: 10/03/2016] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The choice of different laparoscopic approaches of laparoscopic pyeloplasty (LP) in children remains controversial. We present a comparison of different approaches of LP in children and a critical analysis of 11-year experiences in a single surgeon. MATERIALS AND METHODS There were 1750 patients (1889 sides) who underwent LP between 2003 and 2014 reviewed. The diagnosis and outcomes of ureteropelvic junction obstruction (UPJO) were reviewed based on clinical and imaging data. Retroperitoneal laparoscopic pyeloplasty (RPLP) were performed in 451 cases (RPLP group), conventional transperitoneal laparoscopic pyeloplasty (CTLP) were performed in 311 cases (CTLP group), transumbilical single-site laparoscopic pyeloplasty (TSLP) were performed in 322 cases (TSLP group), and transumbilical multiport laparoscopic pyeloplasty (TMLP) were performed in 805 cases (TMLP group). We assessed preoperative clinical data and outcomes, and analyzed the transition experience. Data are expressed as medians for continuous variables. RESULTS The start of oral feeding, hospital stay, and the operative time of RPLP group were 1.10 ± 0.10 days, 5.22 ± 1.32 days, and 138.2 ± 20.1 minutes, respectively. Compared with the other 3 groups, the start of oral feeding was the soonest, hospital stay was the shortest, and the operative time was the longest in the RPLP group (P < .01 or .05). The cosmetic result of the TMLP group was 7.07 ± 1.20 scores, and there are significant differences in cosmetic results between the TMLP group and the other 3 groups (P < .05). CONCLUSION Although the 4 laparoscopic approaches for LP in children with UPJO are safe and efficient procedures with equivalent success rates, we recommend RPLP or TMLP as a treatment option for children with UPJO.
Collapse
Affiliation(s)
- Dehong Liu
- Department of Pediatric Urology, Bayi Children's Hospital, PLA Army General Hospital (formerly The Military General Hospital of Beijing PLA), Beijing, China
| | - Huixia Zhou
- Department of Pediatric Urology, Bayi Children's Hospital, PLA Army General Hospital (formerly The Military General Hospital of Beijing PLA), Beijing, China.
| | - Lifei Ma
- Department of Pediatric Urology, Bayi Children's Hospital, PLA Army General Hospital (formerly The Military General Hospital of Beijing PLA), Beijing, China
| | - Xiaoguang Zhou
- Department of Pediatric Urology, Bayi Children's Hospital, PLA Army General Hospital (formerly The Military General Hospital of Beijing PLA), Beijing, China
| | - Hualin Cao
- Department of Pediatric Urology, Bayi Children's Hospital, PLA Army General Hospital (formerly The Military General Hospital of Beijing PLA), Beijing, China
| | - Tian Tao
- Department of Pediatric Urology, Bayi Children's Hospital, PLA Army General Hospital (formerly The Military General Hospital of Beijing PLA), Beijing, China
| | - Xiaolong Luo
- Department of Pediatric Urology, Bayi Children's Hospital, PLA Army General Hospital (formerly The Military General Hospital of Beijing PLA), Beijing, China
| | - Shaojun Chen
- Department of Pediatric Urology, Bayi Children's Hospital, PLA Army General Hospital (formerly The Military General Hospital of Beijing PLA), Beijing, China
| |
Collapse
|
6
|
Symeonidis EN, Nasioudis D, Economopoulos KP. Laparoendoscopic single-site surgery (LESS) for major urological procedures in the pediatric population: A systematic review. Int J Surg 2016; 29:53-61. [PMID: 27000720 DOI: 10.1016/j.ijsu.2016.03.040] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Revised: 03/06/2016] [Accepted: 03/12/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND Improvements in laparoscopic surgery have led to the introduction of laparoendoscopic single-site surgery (LESS) as an alternative to conventional laparoscopy conferring a number of possible advantages. In this review, we aim to elucidate the aspects of LESS for major urological procedures in the pediatric population. MATERIALS AND METHODS An in-depth search of the literature was performed in the databases of PubMed and Scopus, for studies investigating the technical aspects and clinical outcomes of partial nephrectomies, nephrectomies, nephroureterectomies, varicocelectomies and pyeloplasties in children. Data on parameters such as operation time, instrumentation, perioperative complications, hospital stay and follow up period were collected and further analyzed cumulatively. RESULTS Twenty nine studies met the inclusion criteria incorporating 386 patients who underwent 401 procedures. There were no major intraoperative complications, with only 19 patients (4.73%) facing postoperative complications. No perioperative deaths were reported. CONCLUSIONS In the hands of experienced surgeons LESS seems a feasible, efficient and less invasive alternative to standard laparoscopy in the field of pediatric urology. There is an eminent need of well-designed randomized controlled trials comparing the two techniques.
Collapse
Affiliation(s)
- Evangelos N Symeonidis
- 2nd Department of Urology, Aristotle University of Thessaloniki, Greece; Surgery Working Group, Society of Junior Doctors, Athens, Greece
| | | | - Konstantinos P Economopoulos
- Surgery Working Group, Society of Junior Doctors, Athens, Greece; Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
| |
Collapse
|
7
|
Multi-institutional Experience in Laparoendoscopic Single-site Surgery (LESS): For Major Extirpative and Reconstructive Procedures in Pediatric Urology. Urology 2016; 88:173-8. [DOI: 10.1016/j.urology.2015.11.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Revised: 11/03/2015] [Accepted: 11/05/2015] [Indexed: 12/19/2022]
|
8
|
Khambati A, Wehbi E, Farhat WA. Laparo-endoscopic single site surgery in pediatrics: Feasibility and surgical outcomes from a preliminary prospective Canadian experience. Can Urol Assoc J 2015; 9:48-52. [PMID: 25737756 DOI: 10.5489/cuaj.2379] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Laparo-endoscopic single-site surgery (LESS) is becoming an alternative to standard laparoscopic surgery. Proposed advantages include enhanced cosmesis and faster recovery. We assessed the early post-operative surgical outcomes of LESS surgery utilizing different instruments in the pediatric urological population in Canada. METHODS We prospectively captured data on all patients undergoing LESS at our institution between February 2011 and August 2012. This included patient age, operative time, length of stay, complications and short-term surgical outcomes. Different instruments/devices were used to perform the procedures. Access was achieved through a transumbilical incision. RESULTS A total of 16 LESS procedures were performed, including seven pyeloplasties, four unilateral and one bilateral varicocelectomies, two simple nephrectomies, one renal cyst decortication and one pyelolithotomy. There was no statistical difference in the operative times, hospital length of stay and cost (pyeloplasty only) in patients undergoing pyeloplasty and varicocelectomy using the LESS technique when compared to an age matched cohort of patients managed with the traditional laparoscopic approach. One pyeloplasty in the LESS group required conversion to open due to a small intra-renal pelvis. There were no immediate or short term post-operative complications; however, one patient experienced a decrease in renal function status post LESS pyeloplasty. Since all procedures were performed by a vastly experienced surgeon at a tertiary center, the generalizability of the results cannot be assessed. CONCLUSIONS There are only a few series that have assessed the role of LESS in pediatric urological surgery. Although our experience is limited by a heterogeneous group of patients with a short follow-up period, the present cohort demonstrates the safety and feasibility of LESS. Further evaluation with randomized studies is required to better assess the role of LESS in pediatric urology.
Collapse
Affiliation(s)
- Aziz Khambati
- Division of Urology, Hospital for Sick Children, University of Toronto, Toronto, ON
| | - Elias Wehbi
- Division of Urology, Hospital for Sick Children, University of Toronto, Toronto, ON
| | - Walid A Farhat
- Division of Urology, Hospital for Sick Children, University of Toronto, Toronto, ON
| |
Collapse
|
9
|
Bansal D, Cost NG, Bean CM, Minevich EA, Noh PH. Pediatric urological laparoendoscopic single site surgery: single surgeon experience. J Pediatr Urol 2014; 10:1170-5. [PMID: 24993421 DOI: 10.1016/j.jpurol.2014.04.020] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2013] [Accepted: 04/29/2014] [Indexed: 01/09/2023]
Abstract
OBJECTIVE The aim was to assess the feasibility and outcomes of pediatric urological laparoendoscopic single site (LESS) surgery. MATERIALS AND METHODS A retrospective review was performed of all children who underwent LESS surgery at a single pediatric institution from September 2010 to July 2013. Patient demographics, intraoperative details, narcotic usage, and complications were reviewed. The umbilicus was used as the surgical site in all cases. All procedures were performed with a flexible tip laparoscope, a multichannel port, standard 3- or 5-mm laparoscopic instrumentation, and articulating instruments. RESULTS Sixty-one patients (50 male, 11 female) were identified. Procedures included 18 orchidopexies, 15 nephrectomies, 11 varicocelectomies, nine nephroureterectomies, four partial nephrectomies, one ureterectomy, one ureterolithotomy, one orchiectomy, and one utricle excision. The ureterolithotomy was converted to open surgery for failure to progress. The utricle excision was converted to conventional laparoscopy by adding one accessory port and one skin puncture because of the close proximity of the vas deferens to the utricle. Intraoperative complications included one vas deferens injury during orchidopexy in a postpubertal male. Postoperative complications occurred in six patients: five grade II and one grade IIIb. CONCLUSIONS Pediatric urological LESS procedures are technically feasible, safe, and effective. Further evaluation is warranted to better define its role in pediatric urological surgery.
Collapse
Affiliation(s)
- Danesh Bansal
- Division of Pediatric Urology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, ML 5037, Cincinnati, OH 45229, USA
| | - Nicholas G Cost
- Division of Pediatric Urology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, ML 5037, Cincinnati, OH 45229, USA
| | - Christopher M Bean
- Division of Pediatric Urology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, ML 5037, Cincinnati, OH 45229, USA
| | - Eugene A Minevich
- Division of Pediatric Urology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, ML 5037, Cincinnati, OH 45229, USA
| | - Paul H Noh
- Division of Pediatric Urology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, ML 5037, Cincinnati, OH 45229, USA.
| |
Collapse
|
10
|
Zhou H, Ming S, Ma L, Wang C, Liu X, Zhou X, Xie H, Tao T, Ma S, Cheng W. Transumbilical single-incision laparoscopic versus conventional laparoscopic upper pole heminephroureterectomy for children with duplex kidney: a retrospective comparative study. Urology 2014; 84:1199-204. [PMID: 25443934 DOI: 10.1016/j.urology.2014.07.040] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2014] [Revised: 07/13/2014] [Accepted: 07/22/2014] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To present our experience regarding transumbilical single-incision laparoscopic heminephroureterectomy (SILH) in children with duplex kidney anomalies, and to investigate its feasibility and safety compared with those of conventional laparoscopic heminephroureterectomy (CLH). MATERIALS AND METHODS A matched-pair study comparing 34 SILHs and 34 CLHs performed by a single surgeon from 2007 to 2013 was presented. All SILHs were performed through a 2-cm periumbilical incision by using the port-access system, whereas CLH cases were performed via a transperitoneal 3-port approach. The groups were matched for age, gender, weight, laterality, and surgical indication of the patients. Data including demographics and perioperative and short-term outcomes of the patients were retrospectively compared. RESULTS The 2 groups were comparable in demographics, and surgical indications of the patients (P >.05). No significant difference was observed between SILH and CLH cases in terms of median operative time (105 vs 97 minutes; P = .06), estimated blood loss (22 vs 25 mL; P = .91), interval for oral intake (12 vs 12 hours; P = .69), analgesic requirement (9 vs 6 cases; P = .38), transfusion rate (0% for both; P = 1.00), complication rate (2.9% vs 0%; P = 1.00), postoperative hospital stay (5.0 vs 4.5 days; P = .59), and renal functional loss of the operated side at 3 months after surgery (5.4% vs 5.2%; P = .60). CONCLUSION SILH is feasible and safe in the hands of an experienced pediatric laparoscopic surgeon. Although the outcomes were comparable, better subjective cosmetic results of SILH were achieved.
Collapse
Affiliation(s)
- Huixia Zhou
- Department of Urology, Bayi Children's Hospital Affiliated to Beijing Military Region General Hospital, Beijing, People's Republic of China.
| | - Shaoxiong Ming
- The Second Military Medical University, Shanghai, People's Republic of China
| | - Lifei Ma
- Department of Urology, Bayi Children's Hospital Affiliated to Beijing Military Region General Hospital, Beijing, People's Republic of China
| | - Chao Wang
- Department of Urology, Bayi Children's Hospital Affiliated to Beijing Military Region General Hospital, Beijing, People's Republic of China
| | - Xin Liu
- Department of Urology, Bayi Children's Hospital Affiliated to Beijing Military Region General Hospital, Beijing, People's Republic of China
| | - Xiaoguang Zhou
- Department of Urology, Bayi Children's Hospital Affiliated to Beijing Military Region General Hospital, Beijing, People's Republic of China
| | - Huawei Xie
- Department of Urology, Bayi Children's Hospital Affiliated to Beijing Military Region General Hospital, Beijing, People's Republic of China
| | - Tian Tao
- Department of Urology, Bayi Children's Hospital Affiliated to Beijing Military Region General Hospital, Beijing, People's Republic of China
| | - Sichao Ma
- Department of Urology, Bayi Children's Hospital Affiliated to Beijing Military Region General Hospital, Beijing, People's Republic of China
| | - Wei Cheng
- Department of Paediatrics, Southern Medical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Victoria, Australia; Department of Surgery, Southern Medical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Victoria, Australia; Department of Surgery, Beijing United Family Hospital, Beijing, People's Republic of China
| |
Collapse
|
11
|
Zhou H, Liu X, Xie H, Ma L, Zhou X, Tao T, Ma S, Cheng W. Early experience of using transumbilical multi-stab laparoscopic pyeloplasty for infants younger than 3 months. J Pediatr Urol 2014; 10:854-8. [PMID: 24636485 DOI: 10.1016/j.jpurol.2013.12.025] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2013] [Accepted: 12/20/2013] [Indexed: 10/25/2022]
Abstract
OBJECTIVE Minimally invasive surgery is increasingly being adopted in pediatric urology practice. The aim of this study is to investigate the feasibility and the safety of transumbilical multi-stab laparoscopic pyeloplasty (TMLP) as a treatment for infants younger than 3 months with severe hydronephrosis. METHODS We retrospectively reviewed 63 infants younger than 3 months with severe hydronephrosis who underwent TMLP from June 2010 to March 2013. The operative indications included: 1) prenatal diagnosis of hydronephrosis with anteroposterior renal pelvic diameter greater than 3 cm and Society of Fetal Urology (SFU) Grade 4 hydronephrosis; 2) ipsilateral differential renal function being less than 40%. Patients were followed up with physical examinations, ultrasound and radionuclide scans. RESULTS The operations were successfully performed in all 63 patients. There was no conversion, no requirement of additional trocar placement and no intraoperative complication. The median age was 54 (47-87) days. The median operative time was 75 (53-118) minutes. The patients were followed up for 12 (6-36) months. The anastomoses were proved to be patent and the renal parenchymal thickness increased. The renal pelvic anteroposterior diameters were reduced and the renal functions were improved (p < 0.01). In addition, the scars were barely noticeable. CONCLUSIONS TMLP for infants younger than 3 months with severe hydronephrosis is feasible, safe and minimally invasive. The cosmetic results are excellent.
Collapse
Affiliation(s)
- Huixia Zhou
- Department of Urology, Bayi Children's Hospital Affiliated to Beijing Military Region General Hospital, Beijing, People's Republic of China.
| | - Xin Liu
- Department of Urology, Bayi Children's Hospital Affiliated to Beijing Military Region General Hospital, Beijing, People's Republic of China; Medical School, Nankai University, Tianjin, People's Republic of China
| | - Huawei Xie
- Department of Urology, Bayi Children's Hospital Affiliated to Beijing Military Region General Hospital, Beijing, People's Republic of China
| | - Lifei Ma
- Department of Urology, Bayi Children's Hospital Affiliated to Beijing Military Region General Hospital, Beijing, People's Republic of China
| | - Xiaoguang Zhou
- Department of Urology, Bayi Children's Hospital Affiliated to Beijing Military Region General Hospital, Beijing, People's Republic of China
| | - Tian Tao
- Department of Urology, Bayi Children's Hospital Affiliated to Beijing Military Region General Hospital, Beijing, People's Republic of China
| | - Sichao Ma
- Department of Urology, Bayi Children's Hospital Affiliated to Beijing Military Region General Hospital, Beijing, People's Republic of China
| | - Wei Cheng
- Department of Pediatrics and Surgery, Southern Medical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Australia.
| |
Collapse
|
12
|
Wagmaister J, Kocherov S, Chertin B. Laparoscopic single site surgery: Experience in pediatric urology. World J Clin Urol 2014; 3:119-126. [DOI: 10.5410/wjcu.v3.i2.119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2013] [Accepted: 03/14/2014] [Indexed: 02/06/2023] Open
Abstract
Laparoendoscopic single-site surgery (LESS) has been developed to benefit patients by enabling surgeons to perform scarless surgery. In this review we aimed to summarize and critically analyze the available evidence on the current status and future prospects for LESS in pediatric urology, with special emphasis on our experience with LESS in children. The clinical data available clearly demonstrate that LESS can safely and effectively be performed in a variety of pediatric urology settings. As clinical experience increases, expanding indications are expected to be documented and the efficacy of the procedure to improve. So far, the quality of evidence of all available studies remains low; mostly being small case series or case-control studies from selected centers. Thus, the only objective benefit of LESS remains improved cosmetic outcome. Prospective randomized studies are awaited to determine which LESS procedures will be established and which are unlikely to stand the test of time. Technological advances hold promise to minimize the challenging technical nature of scarless surgery. In this respect, robotics may be a driving force in the development of LESS.
Collapse
|
13
|
Noh PH, Vinson MA, Bansal D. LaparoEndoscopic Single Site orchidopexy for intra-abdominal testes in the pediatric population with a multichannel single port and flexible tip laparoscope. J Endourol 2013; 27:1381-3. [PMID: 23750538 DOI: 10.1089/end.2013.0182] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE To assess the outcomes of pediatric LaparoEndoscopic Single Site (LESS) orchidopexy using a commercially available multi-channel single port (MCSP) and flexible tip laparoscope (FTL). PATIENTS AND METHODS A retrospective cohort study was performed of children who underwent LESS orchidopexy by a single surgeon at a pediatric institution. A commercially available MCSP was utilized at the umbilicus. A 5 mm FTL and 3 mm and 5 mm instruments were used for the dissection. Follow-up visits were performed 2-4 weeks and 6-12 months after surgery to assess position and size of the testes. RESULTS A total of 17 patients were identified. Median age was 11 months (range 3-43). Sixteen patients underwent primary orchidopexy, including two bilateral procedures and five primary Fowler-Stephens (FS) procedures. One patient underwent a staged FS orchidopexy, with the LESS technique utilized during the second stage. Median laparoscopic dissection time for each testis was 35 minutes (range 22-40). There was no blood loss or intraoperative complications. All testes were noted to be in the scrotum without testicular atrophy. CONCLUSIONS Our initial experience with this technique was favorable with excellent outcomes. LESS orchidopexy is facilitated with a MCSP and FTL.
Collapse
Affiliation(s)
- Paul H Noh
- Division of Pediatric Urology, Cincinnati Children's Hospital Medical Center , Cincinnati, Ohio
| | | | | |
Collapse
|
14
|
Tsai YC, Ho CH, Lin VCH, Jaw FS. Ergonomic principles and techniques in facilitating advanced laparoendoscopic single site (LESS) urinary tract reconstruction with conventional laparoscopic instruments. J Formos Med Assoc 2013; 114:698-703. [PMID: 23856347 DOI: 10.1016/j.jfma.2013.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2013] [Revised: 05/23/2013] [Accepted: 06/04/2013] [Indexed: 10/26/2022] Open
Abstract
BACKGROUND/PURPOSE The technical and ergonomic details of laparoendoscopic single site (LESS) reconstruction have not been reported. In this study, we explored the feasibility and safety of performing advanced LESS upper urinary tract reconstruction with conventional laparoscopic instruments. METHODS Between September 2010 and March 2011, we retrospectively reviewed prospectively collected data from five patients who underwent LESS urinary tract reconstruction. The LESS reconstruction included pyeloureterostomy (N = 1), dismembered pyeloplasty (N = 2), ureteroneocystostomy (N = 1), and ureteroplasty for bifid blind ending ureter (N = 1). The perioperative and postoperative parameters were collected for analysis. The ergonomic principles and techniques are detailed. RESULTS All reconstructive LESS procedures were completed successfully without open conversion or laparoscopic conversion. Ancillary ports or ancillary instruments were not applied in any of the patients. The mean patient age was 40.4 years. The mean operative time was 213 ± 69 minutes, the estimated blood loss ranged from minimal to 50 mL, and the mean hospital stay was 4.4 ± 4 days. No operation-related complication occurred. CONCLUSION Based on our ergonomic principles and suturing/knotting techniques, conventional laparoscopic instruments are feasible and safe for LESS urinary reconstructive procedures.
Collapse
Affiliation(s)
- Yao-Chou Tsai
- Institute of Biomedical Engineering, National Taiwan University, Taipei, Taiwan; Division of Urology, Department of Surgery, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taipei, Taiwan; Department of Urology, Tzu Chi University, Medical College, Hualien, Taiwan.
| | - Chen-Hsun Ho
- Department of Urology, National Taiwan University Hospital, Taipei, Taiwan
| | | | - Fu-Shan Jaw
- Institute of Biomedical Engineering, National Taiwan University, Taipei, Taiwan
| |
Collapse
|
15
|
Rais-Bahrami S, Rizkala ER, Cadeddu JA, Tugcu V, Derweesh IH, Abdel-Karim AM, Kawauchi A, George AK, Autorino R, Bagrodia A, Sonmezay E, Elsalmy S, Liss MA, Harrow BM, Kaouk JH, Richstone L, Stein RJ. Laparoendoscopic single-site pyeloplasty: outcomes of an international multi-institutional study of 140 patients. Urology 2013; 82:366-72. [PMID: 23810729 DOI: 10.1016/j.urology.2013.04.047] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2013] [Revised: 04/25/2013] [Accepted: 04/29/2013] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To report an international, multi-institutional series of laparoendoscopic single-site pyeloplasty (LESS-P) with analysis of functional outcomes. MATERIALS AND METHODS LESS-P cases performed between October 2007 and June 2012 at 7 institutions worldwide per individual institutional protocols, entry criteria, and techniques were included. Patient characteristics, operative indications, perioperative outcomes, and postoperative follow-up were retrospectively collected and analyzed. RESULTS The study included 140 adult patients (age 39.9 ± 15.7 years; body mass index 24.8 ± 4.2 kg/m(2); 15% with previous abdominal surgery) who underwent unilateral LESS-P, most of whom (94.3%) had dismembered reconstructions. Mean operative time was 202.1 ± 47 minutes with an estimated blood loss of 61.2 ± 44.6 mL. Robotic laparoendoscopic single-site surgery was applied in 31 patients (22.1%). A single 2-3 mm accessory port was used in 44 patients (31.4%) and a single 5-12 mm accessory port was added in 9 patients (6.4%), whereas 10 patients (7.1%) were converted to conventional multiport laparoscopy. No patients required conversion to open surgery, nor were any intraoperative complications reported. Length of hospitalization was 2.4 ± 1.6 days. The overall 90-day postoperative complication rate was 18.6%, mostly low-grade complications (Clavien I-II). With a mean follow-up of 14.0 ± 10.8 months, 93.4% had resolution of symptoms and 94.4% had radiographic evidence demonstrating resolution of ureteropelvic junction obstruction. Assessment of drainage with diuretic nuclear renal scan provided evidence of improvement in 86.5% of patients on their first postoperative renal scan. CONCLUSION This study highlights the most comprehensive experience with LESS-P reported to date. Outcome measures parallel those of large published series of conventional laparoscopic pyeloplasty. Despite these encouraging findings, longer follow-up is needed to determine the efficacy and durability of this approach for the treatment of ureteropelvic junction obstruction.
Collapse
Affiliation(s)
- Soroush Rais-Bahrami
- The Arthur Smith Institute for Urology, Hofstra North Shore-LIJ School of Medicine, New Hyde Park, NY, USA.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
16
|
Scarless Pyeloplasty in the Pediatric Population. Urology 2012; 80:200-2. [DOI: 10.1016/j.urology.2012.03.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2012] [Revised: 03/03/2012] [Accepted: 03/09/2012] [Indexed: 12/15/2022]
|