1
|
Mosa H, Giannettoni A, Patil K, Mishra P, Taghizadeh A, Paul A, Garriboli M. Pediatric Nephrectomy: Comparison of Perioperative Outcomes of Three Different Minimally Invasive and Open Approaches. J Laparoendosc Adv Surg Tech A 2021; 31:1466-1470. [PMID: 34847738 DOI: 10.1089/lap.2021.0343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Minimally invasive surgery (MIS) is now the gold standard for nephrectomy in pediatric patients. Retroperitoneoscopic (using either one or two instruments) and transperitoneal (TP) approaches are described. We compared the perioperative outcomes of different techniques [single-instrument retroperitoneoscopic (SIRP), two-instrument retroperitoneoscopic (TIRP), TP, and open approach]. Patients and Methods: Retrospective review of patients who underwent nephrectomy surgery in the period from January 2009 to January 2020 at a single center was carried out. We excluded patients who underwent other procedures under the same anesthetic, underwent heminephrectomy, and those with incomplete records. The primary outcome measures were operative time, intraoperative complications, postoperative complications, and length of hospital stay. One-way analysis of variance (ANOVA) test was used to analyze continuous variables. Chi square test was used to compare categorical variables. Results: A total of 213 nephrectomies were analyzed; SIRP (n = 35), TIRP (n = 50), TP (n = 74), and open (n = 54). Median age (months) was 71 for SIRP, 113 for TIRP, 67 for TP, and 21 for open. No statistical difference was identified for mean operative time (P = .067) or mean hospital stay (P = .69). Intraoperative complications were significantly more in the open group (P = .03). Postoperative complications were rare and only noted in the open group. There was no conversion to open surgery in the SIRP and TIRP groups. Conversion rate was 5.4% (4/74) in the TP group. Conclusion: MIS nephrectomy is safe, and no difference among techniques (SIRP, TIRP and TP) has been demonstrated. They are comparable to open surgery in terms of operative time and hospital stay, but are associated with significantly less complications.
Collapse
Affiliation(s)
- Hazem Mosa
- Paediatric Urology, Evelina London Children's Hospital, London, United Kingdom
| | - Adele Giannettoni
- Paediatric Urology, Evelina London Children's Hospital, London, United Kingdom
| | - Kalpana Patil
- Paediatric Urology, Evelina London Children's Hospital, London, United Kingdom
| | - Pankaj Mishra
- Paediatric Urology, Evelina London Children's Hospital, London, United Kingdom
| | - Arash Taghizadeh
- Paediatric Urology, Evelina London Children's Hospital, London, United Kingdom
| | - Anu Paul
- Paediatric Urology, Evelina London Children's Hospital, London, United Kingdom
| | - Massimo Garriboli
- Paediatric Urology, Evelina London Children's Hospital, London, United Kingdom.,Stem Cells & Regenerative Medicine Section, Developmental Biology & Cancer Programme, UCL Institute of Child Health, Evelina Children's Hospital, London, United Kingdom
| |
Collapse
|
2
|
Sarhan OM. Laparoscopic nephrectomy in children: Does the approach matter? J Pediatr Urol 2021; 17:568.e1-568.e7. [PMID: 34053858 DOI: 10.1016/j.jpurol.2021.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 04/11/2021] [Accepted: 05/07/2021] [Indexed: 10/21/2022]
Abstract
INTRODUCTION AND OBJECTIVE Laparoscopic nephrectomy (LN) is an established technique for the management of benign non-functioning kidneys in children. It can be performed either by the transperitoneal (TP) or retroperitoneal (RP) approach. The aim of this study was to compare safety and efficacy of TP with RP approach for LN in children. STUDY DESIGN Between 2007 and 2019, 79 consecutive pediatric patients with benign non-functioning kidneys underwent laparoscopic nephrectomy by a single surgeon. Patients were categorized into two groups according to the approach; Group 1 included 41 patients who underwent transperitoneal laparoscopic nephrectomy (TPLN), while Group 2 included 38 patients who underwent retroperitoneal laparoscopic nephrectomy (RPLN). Comparison was done between the two groups regarding the mean operative time, complications, time to resume oral intake, need for postoperative analgesia and postoperative hospital stay. RESULTS Laparoscopic nephrectomy was successfully completed in 75 of the 79 cases. Four cases were converted to open surgery: 3 from the TPLN group and one from the RPLN group (p = 0.34). There was statistically significant difference between the two groups in terms of estimated blood loss (p = 0.013), time to resume oral intake (p = 0.001) and postoperative hospital stay (p = 0.024). Overall, there was no statistically significant difference as regard mean operative time, overall complication rate, and postoperative analgesia need. DISCUSSION LN is now an established technique in children and surgeon experience is a limiting factor. This experience should be gained progressively with respect to both TP and RP approaches to deal with different indications by optimal approach. Both TP and RP approaches are excellent approaches and it is up to individual surgeons, based on their experience, which approach they select. In this study, a comparative study was made between both TP and RP approaches for pediatric LN. There was no statistically significant difference between the two approaches as regard success rate, mean operative time, need for postoperative analgesia and overall complication rate. In the meantime, RPLN had the advantage of lower intraoperative blood loss, shorter time to resume oral intake and shorter hospital stay. CONCLUSIONS Laparoscopic nephrectomy in children may be performed by transperitoneal or retroperitoneal approaches, obtaining equal safety and efficacy. The retroperitoneal approach seems to be advantageous in terms of lower intraoperative blood loss, time to resume oral intake and shorter postoperative hospital stay.
Collapse
Affiliation(s)
- Osama M Sarhan
- Mansoura Urology and Nephrology Center, Faculty of Medicine, Mansoura University, Mansoura, Egypt.
| |
Collapse
|
3
|
Cezarino BN, Lopes RI, Berjeaut RH, Dénes FT. Laparoscopic hidden incision endoscopic surgery (hides) nephrectomy VS. Traditional laparoscopic nephrectomy: Non-inferior surgical outcomes and better cosmetic results. J Pediatr Urol 2021; 17:411.e1-411.e6. [PMID: 33546978 DOI: 10.1016/j.jpurol.2021.01.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 11/30/2020] [Accepted: 01/14/2021] [Indexed: 11/16/2022]
Abstract
INTRODUCTION The benefits of laparoscopic total nephrectomy in pediatric patients are well established. Traditional Ports placement (TPP) still follows Clayman's classic description: except for the umbilical scar, the other laparoscopic scars are exposed in the abdomen. Advances in robotic surgery permitted the development of HidES (hidden incision endoscopic surgery) technique, to obtain a better final cosmetic aspect with the scars located intraumbilically and in the hypogastric region, in an area easily hidden by underwear. As robotic surgery is related to higher costs and lacks availability, a pure laparoscopic HidES technique was developed. OBJECTIVES 1.Evaluate safety and efficacy of pure laparoscopic HidES.2. Compare HidES with TPP nephrectomy series to assess non-inferiority and cosmetic outcomes. STUDY DESIGN Twenty-one pediatric patients with symptomatic poor functioning kidneys (DMSA<10%) underwent HidES nephrectomy. Their intra and post-operative outcomes were recorded prospectively. HidES group was compared to an equivalent group of thirty-two patients who underwent TPP nephrectomy. RESULTS There were no conversions to open surgery in the TPP or HidES groups. There was a significant difference in operative time between HidES (53.4min) and TPP (109.4 min), with p = 0.004 and the mean bleeding volume was 65.5 ml. There was no significant difference in bleeding between HidES (71 ml) and TPP (120 ml) (p = 0.06), no intraoperative complications and no complications above Clavien-Dindo II during the 6-week follow-up. Satisfaction reached 100% in HidES group, whereas in TPP satisfaction was 63% (p = 0.004). DISCUSSION HidES benefit over TPP is to conceal visible scars above underwear, improving cosmetical outcome. A prospective HidES group was compared to a retrospective TPP database due to decreasing number of nephrectomies being performed, which is a limitation of our study. HidES surgeries were performed by pediatric urologists (associate staff) while TPP group surgeries were performed by PGY-5 urological residents assisted by the associate staff, which is a clear limitation and can explain shorter operative times for HidES. During HidES surgeries an improved visualization of the operative field by the inferior trocar positioning was noted, which helps the posterior dissection of renal pedicle. Previous published study comparing robotic TPP and HidES pyeloplasty showed equal results for both groups with cosmetic advantages. Objective satisfaction was assessed with statistically advantage in favor of HidES procedure, consonant with other evidence that supports the benefit of scar location in patient and parental satisfaction. CONCLUSION HidES nephrectomy proved to be safe, feasible and not inferior to the traditional nephrectomy in experienced hands, with better cosmesis.
Collapse
Affiliation(s)
- Bruno Nicolino Cezarino
- Pediatric Urology Unit, Division of Urology, Hospital Das Clínicas, University of São Paulo Medical School, Brazil.
| | - Roberto Iglesias Lopes
- Pediatric Urology Unit, Division of Urology, Hospital Das Clínicas, University of São Paulo Medical School, Brazil
| | - Ricardo Haidar Berjeaut
- Pediatric Urology Unit, Division of Urology, Hospital Das Clínicas, University of São Paulo Medical School, Brazil
| | - Francisco Tibor Dénes
- Pediatric Urology Unit, Division of Urology, Hospital Das Clínicas, University of São Paulo Medical School, Brazil
| |
Collapse
|
4
|
Abstract
Nephrectomy is, perhaps, one of the techniques in which laparoscopic approach has been widely used. It has quickly evolved since Clayman introduced it in 1990 with a renal tumor. Since then, its goodness has been extrapolated to most entities that require surgical removal of the kidney. We review the current most discussed aspects referred to the main laparoscopic nephrectomy techniques (simple nephrectomy, nephroureterectomy, radical, and nephron-sparing nephrectomy) and particularities of this approach.
Collapse
|
5
|
Esposito C, Miyano G, Caione P, Escolino M, Chiarenza F, Riccipetitoni G, Yamataka A, Cerulo M, Savanelli A, Settimi A, Valla JS. Retroperitoneoscopic Heminephrectomy in Duplex Kidney in Infants and Children: Results of a Multicentric Survey. J Laparoendosc Adv Surg Tech A 2015; 25:864-9. [PMID: 26390256 DOI: 10.1089/lap.2014.0654] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
PURPOSE Retroperitoneoscopic partial nephrectomy (RPN) in children is considered a complex technique with limited diffusion among pediatric surgeons and urologists. We aimed to report the outcome of this technique in infants and children with duplex kidney in a 5-year retrospective multicentric international survey. MATERIALS AND METHODS Data on 50 children who underwent RPN (41 upper-pole nephrectomies and 9 lower-pole nephrectomies) were retrospectively collected in this six-institution survey. Median age at surgery was 3.3 years. There were 35 girls and 15 boys. The left side was affected in 28 patients, versus the right side in 22 patients. We assessed intraoperative and postoperative morbidity. Follow-up (median, 2.5 years; range, 12 months-5 years) was based on clinical controls and echo color Doppler renal ultrasound scans. RESULTS Median duration of surgery was 255 minutes. Surgery was always performed with the patient in a lateral position. Special hemostatic devices were used for dissection and parenchymal section in all centers. Three patients from two centers (6%) required conversion to open surgery. We recorded seven complications (six peritoneal perforations, one opening of the remaining calyxes) in the 50 cases. Re-operation rate was 0%. Average length of hospital stay was 4.1 days. CONCLUSIONS Our survey shows that RPN remains a challenging procedure with a long learning curve, performed only in pediatric centers with huge experience in this field. In our survey operative time was longer than 4 hours. The complication rate remains high (7/50, or 14%), with complications classified as Grade II according to the Clavien-Dindo classification. They did not require further surgery, but they were associated with a prolonged hospital stay.
Collapse
Affiliation(s)
- Ciro Esposito
- 1 Department of Translational Medical Sciences, "Federico II" University of Naples , Naples, Italy
| | - Go Miyano
- 2 Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine , Tokyo, Japan
| | - Paolo Caione
- 3 Department of Pediatric Urology, Bambino Gesù Hospital , Rome, Italy
| | - Maria Escolino
- 1 Department of Translational Medical Sciences, "Federico II" University of Naples , Naples, Italy
| | - Fabio Chiarenza
- 4 Department of Pediatric Surgery, San Bortolo Hospital , Vicenza, Italy
| | | | - Atsuyuki Yamataka
- 2 Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine , Tokyo, Japan
| | - Mariapina Cerulo
- 1 Department of Translational Medical Sciences, "Federico II" University of Naples , Naples, Italy
| | - Antonio Savanelli
- 1 Department of Translational Medical Sciences, "Federico II" University of Naples , Naples, Italy
| | - Alessandro Settimi
- 1 Department of Translational Medical Sciences, "Federico II" University of Naples , Naples, Italy
| | | |
Collapse
|
6
|
Menon P, Handu AT, Rao KLN, Arora S. Laparoscopic nephrectomy in children for benign conditions: indications and outcome. J Indian Assoc Pediatr Surg 2014; 19:22-7. [PMID: 24604980 PMCID: PMC3935295 DOI: 10.4103/0971-9261.125953] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
AIM To analyze the indications and outcome of laparoscopic nephrectomy for benign non-functioning kidneys in children. MATERIALS AND METHODS The data of all patients operated over a 10 year period was retrospectively analyzed. RESULTS There were 56 children, aged 4 months to 12 years with a male: female ratio of 2.3:1. The most common presentation in boys and girls was urinary tract infection (UTI) (61.5% and 47.05% respectively). Incontinence due to ectopic ureter was a close second in girls (41.17%). The most common underlying conditions were vesico-ureteric reflux (42.85%) and multicystic dysplastic kidney (23.2%). There were 6 nephrectomies, 4 heminephroureterectomies and the remaining nephroureterectomies. All children tolerated the surgery well. One patient underwent a concomitant cholecystectomy. The post-operative problems encountered were UTI (1), urine retention (1), pyonephrosis in the opposite kidney and development of contra-lateral reflux (1). All others had resolution of pre-operative symptoms with good cosmesis. CONCLUSIONS As per available literature, this appears to be the largest Indian series of pediatric laparoscopic nephrectomies for benign non-functioning kidneys. Laparoscopic approach gives excellent results provided pre-operative investigations rule out other causes for the symptoms with which the patient presents. Often it is not the kidney but the dilated dysplastic ureter which is the seat of stasis and infection or pain and therefore should be completely removed.
Collapse
Affiliation(s)
- Prema Menon
- Department of Pediatric Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Abhilasha T Handu
- Department of Pediatric Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India ; Department of Surgery, Bharati Hospital and Research Centre, Dhankawadi, Pune, India
| | | | - Suman Arora
- Department of Anesthesia and Intensive Care, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| |
Collapse
|
7
|
Upper pole nephrectomy: a simplified technique using a retroperitoneal laparoscopic approach. Case Rep Urol 2011; 2011:570790. [PMID: 22606619 PMCID: PMC3350178 DOI: 10.1155/2011/570790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2011] [Accepted: 10/04/2011] [Indexed: 11/28/2022] Open
Abstract
Objective. To describe a simplified technique already used in our institution for several years in the open heminephrectomy for duplication anomalies, now performed through a retroperitoneal laparoscopic approach. Methods. The technique begins with upper pole parenchyma incision since the demarcation between the affected upper moiety and the healthy lower pole is easily established. The dissection proceeds until the urothelium of the collecting system is entered, which will guide further excision, minimizing damage of the surrounding structures. The vascular supply is then identified since the upper pole is attached to the remaining renal parenchyma only by these structures that can be safely divided. Dissection and division of the ectopic ureter is carried next. Results. The operative time was 188 minutes. The blood loss was not significant, and there were no other complications during the procedure. The patient was discharged home 48 hours after the procedure, without any early or late postoperative complications. Conclusion. We believe this simplified technique allows a safer excision of nonfunctioning upper pole renal tissue by avoiding the initial dissection of the renal hilum, which associated with the known advantages of a laparoscopic approach makes us consider it the procedure of choice for upper pole nephrectomy in children.
Collapse
|
8
|
Choi JM, Bayne AP, Bian SX, Roth DR, Cisek LJ. A Single-Center Experience with Prone Retroperitoneoscopic Versus Open Renal Surgery in Children: An Age- and Procedure-Matched Comparison. J Endourol 2011; 25:1563-72. [DOI: 10.1089/end.2010.0699] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Judy M. Choi
- Scott Department of Urology, Baylor College of Medicine, Houston, Texas
| | - Aaron P. Bayne
- Scott Department of Urology, Baylor College of Medicine, Houston, Texas
- Department of Pediatric Urology, Texas Children's Hospital, Houston, Texas
| | - Shelly X. Bian
- Scott Department of Urology, Baylor College of Medicine, Houston, Texas
| | - David R. Roth
- Scott Department of Urology, Baylor College of Medicine, Houston, Texas
- Department of Pediatric Urology, Texas Children's Hospital, Houston, Texas
| | - Lars J. Cisek
- Scott Department of Urology, Baylor College of Medicine, Houston, Texas
- Department of Pediatric Urology, Texas Children's Hospital, Houston, Texas
| |
Collapse
|
9
|
Kim PH, Patil MB, Kim SS, Dorey F, De Filippo RE, Chang AY, Hardy BE, Gill IS, Desai MM, Koh CJ. Early comparison of nephrectomy options in children (open, transperitoneal laparoscopic, laparo-endoscopic single site (LESS), and robotic surgery). BJU Int 2011; 109:910-5. [DOI: 10.1111/j.1464-410x.2011.10524.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
|
10
|
Chander J, Gupta N, Lal P, Lal P, Ramteke VK. Retroperitoneal laparoscopic pyelolithotomy versus extra corporeal shock-wave lithotripsy for management of renal stones. J Minim Access Surg 2011; 6:106-10. [PMID: 21120067 PMCID: PMC2992658 DOI: 10.4103/0972-9941.72596] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2010] [Accepted: 07/01/2010] [Indexed: 11/24/2022] Open
Abstract
AIM: The purpose of this study was to evaluate the role of retroperitoneal laparoscopic pyelolithotomy (RPPL) and its comparison with extra corporeal shock wave lithotripsy in the management of renal calculi. MATERIALS AND METHODS: The study was carried out in the Department of surgery, Maulana Azad Medical College, New Delhi, India. The study included 86 cases of solitary renal calculi in the retroperitoneoscopic (RPPL) group and 82 cases in the shock wave lithotripsy (SWL) group. The parameters compared were stone clearance, hospital stay, number of postoperative visits, mean time to resume normal activities, number of man days lost, and analgesic requirement. RESULTS: The RPPL group showed better stone clearance, fewer hospital visits, low analgesic requirement, fewer number of man days lost, and early resumption of normal activities, as compared to the SWL group. CONCLUSIONS: Shock wave lithotripsy, being a noninvasive modality, is an established procedure all over the world. However RPPL achieves comparable or better results in high volume centers.
Collapse
Affiliation(s)
- Jagdish Chander
- Department of Surgery, Maulana Azad Medical College, New Delhi - 110 002, India
| | | | | | | | | |
Collapse
|
11
|
Paediatric computer-assisted retroperitoneoscopic nephrectomy compared with open surgery. Pediatr Surg Int 2011; 27:761-7. [PMID: 21327553 DOI: 10.1007/s00383-011-2860-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/26/2011] [Indexed: 12/25/2022]
Abstract
PURPOSE Computer-assisted laparoscopic surgery (CALS) in children is increasingly used and has proven to be feasible and safe. However, its full potential remains unclear and clinical comparative studies hardly exist. The aim of this study was to prospectively evaluate our experience with CALS for performing retroperitoneal nephrectomies in children when compared with controls undergoing open surgery in terms of safety, operative time, blood loss, opoid requirements, the duration of hospital stay and complications. CHILDREN AND METHODS Computer-assisted retroperitoneoscopic nephrectomy was undertaken in ten consecutive children, mean age at the time of surgery 6.4 (SD ± 4.5) years, and compared with a retrospectively collected control group of all other children, mean age 3.9 (SD ± 4.6) years, who underwent the same procedure by conventional open surgery between the years 2005 and 2009. The endpoint of the study was 1 month postoperatively. RESULTS Nephrectomies were performed in all the children and no child was excluded from the study. There was no per-operative complication in any of the groups. The median (range) operative time was 202 (128-325) and 72 (44-160) min for the CALS and open group, respectively. The blood loss was minimal (<20 ml) for all the patients. The postoperative opoid requirements did not differ. The median (range) postoperative hospital stay was 1 (1-4) and 2 (1-7) days for the CALS and the open group, respectively. One complication in the form of an urinoma appeared 5 days after surgery in the CALS group. CONCLUSION Computer-assisted retroperitoneoscopic nephrectomy is a safe, feasible and effective procedure in children. Even though operative times are longer the patients benefit from the lower morbidity, improved cosmetics and shorter hospitalization associated with the minimally invasive approach.
Collapse
|
12
|
Castillo O, Foneron-Villarroel A, López-Fontana G, Bolufer E, Rodríguez-Carlin A. [Laparoscopic nephrectomy in children]. Actas Urol Esp 2011; 35:195-9. [PMID: 21419515 DOI: 10.1016/j.acuro.2010.12.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2010] [Revised: 12/07/2010] [Accepted: 12/11/2010] [Indexed: 01/15/2023]
Abstract
INTRODUCTION Laparoscopic nephrectomy in children, not as in the adult population, has evolved more slowly due to the misleading concept that children require small incisions and recover faster. The aim of this article is to present our experience in laparoscopic renal surgery in a paediatric population. MATERIAL AND METHODS We checked the clinical records of children that were subjected to laparoscopic renal surgery at our institution between May 1993 and September 2010. We recorded the data prospectively and analysed it retrospectively. The variables we studied were surgical indication, age, sex, procedure and approach, surgery time, hospital stay, intraoperative bleeding, perioperative complications, conversion to open surgery, reintervention and blood transfusion rates. RESULTS Between May 1993 and September 2010, we operated a total of 72 patients, 45 nephrectomies (62.5%), 13 nephroureterectomies (18%) and 14 heminephrectomies (19.4%). The mean age was 68 months (range 3-168). The mean surgery time was 80.4 min. (range: 25-270 min.) with a estimated mean blood loss of 37.5 ml (range: 0 -1.000 ml). There were 3 (4.1%) conversions to open surgery. One was due to intraoperative bleeding and the other two were secondary to a difficult dissection due to a history of prior renal surgical interventions. The mean hospital stay was 3.17 days (range: 1-30 days) and there were 7 (9.72%) postoperative complications. There were no deaths. CONCLUSIONS We consider the laparoscopic approach for renal surgery in paediatric patients to be a feasible, safe and effective procedure that must be considered as the first option for the treatment of benign pathology in this population group.
Collapse
|
13
|
Szymanski KM, Bitzan M, Capolicchio JP. Is retroperitoneoscopy the gold standard for endoscopic nephrectomy in children on peritoneal dialysis? J Urol 2010; 184:1631-7. [PMID: 20728139 DOI: 10.1016/j.juro.2010.04.019] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2009] [Indexed: 11/27/2022]
Abstract
PURPOSE The literature on minimally invasive nephrectomy in adults and children on peritoneal dialysis is sparse. Case reports suggest that the transperitoneal approach is effective. We present our experience with retroperitoneoscopic nephrectomy in children on peritoneal dialysis. MATERIALS AND METHODS At 11 consecutive retroperitoneoscopic nephrectomies a total of 14 kidneys were removed from 10 children with a mean age of 12 years. We used a 3-port lateral retroperitoneoscopic nephrectomy technique with active trainee participation. Preoperative and postoperative biochemistry results within 3 months of surgery were compared with the Wilcoxon signed rank test. RESULTS Three bilateral synchronous, 1 bilateral staged and 6 unilateral retroperitoneoscopic nephrectomies were done. Mean operative time was 174 minutes for unilateral and 458 minutes for bilateral nephrectomy, including 1 simultaneous peritoneal dialysis insertion and 1 umbilical hernia repair. No open conversion, blood transfusion or postoperative surgical complication was noted. Peritoneal dialysis was initiated at a median of 9 hours postoperatively and dialysate volume was titrated to target within a median of 60 hours. One patient with a small peritoneotomy needed temporary hemodialysis despite intraoperative airtight repair. After surgery median serum albumin increased from 30.0 to 34.3 gm/l. CONCLUSIONS Retroperitoneoscopic nephrectomy for end stage renal disease is a safe, effective technique that preserves peritoneal integrity in children who require immediate postoperative peritoneal dialysis. Avoiding post-nephrectomy hemodialysis decreases patient morbidity, preserving vessels for future vascular access. Compared to the literature on laparoscopy in this setting, retroperitoneoscopic nephrectomy can be considered the ideal approach for minimally invasive nephrectomy in patients on peritoneal dialysis.
Collapse
Affiliation(s)
- Konrad M Szymanski
- Division of Urology, Montreal Children's Hospital, McGill University, Montreal, Quebec, Canada
| | | | | |
Collapse
|
14
|
Traxel EJ, Minevich EA, Noh PH. A Review: The Application of Minimally Invasive Surgery to Pediatric Urology: Upper Urinary Tract Procedures. Urology 2010; 76:122-33. [PMID: 20303151 DOI: 10.1016/j.urology.2009.11.072] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2009] [Revised: 11/20/2009] [Accepted: 11/28/2009] [Indexed: 12/26/2022]
Affiliation(s)
- Erica J Traxel
- Division of Pediatric Urology, St. Louis Children's Hospital, Washington University School of Medicine, St. Louis, Missouri, USA.
| | | | | |
Collapse
|
15
|
Scafuri A, Miranda E, Dénes F, Castilho L, Mitre A, Arap S. Comparación entre la cirugía videolaparoscópica y la cirugía abierta para las enfermedades renales benignas en el niño. Actas Urol Esp 2009; 33:1115-21. [DOI: 10.1016/s0210-4806(09)73190-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
16
|
de Lorca APL, Fraile AG, Bramtot AA, Brabancho DC, Vázquez FL, Fernández JC. [Complications in laparoscopy renal surgery in pediatric age: analysis of our experience and literature review]. Actas Urol Esp 2009; 33:670-80. [PMID: 19711751 DOI: 10.1016/s0210-4806(09)74206-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
INTRODUCTION The development of the minimally invasive surgery in pediatric age has been slower than in the adult age since their advantages are not so clear. The learning curve and the complications presented during this period, as well as the type of material used has been the factors that have contributed to this fact. OBJECTIVE We collected our experience and the complications presented in renal laparoscopic exegesis surgery, adding a review of the published literature to date. MATERIALS AND METHODS Retrospective study of our clinical cases in that we practiced laparoscopic renal exegesis surgery. We collected 56 cases from January 2003, when it was implanted, to September 2008. We had 36 boys (64%) and 20 girls (36%). The mean age was 3.6 years. We analyzed principal diagnosis, the situation that conducted to the surgery and the type of surgery performed, time of surgery, hospital stay and complications with their solution. The results were analyzed the statistical program SPSS (SPSSCorp, Chicago, Illinois). The literature review was practiced in MEDLINE, EMBASE and COCHRANE database. The selected works were reviewed by two investigators. Series containing adults were excluded. RESULTS We perfomed 42 nephrectomies (75%), 13 heminephrectomies (23%) and 1 quistectomy (2%). 5 cases (9%) were done by retroperitoneoscopy and 51 cases (91%) transperitoneally. The mean operative time was 118 +/- 0,75 min, for nephrectomies; 192 +/- 1.07 min, for partial nephrectomies, 111 +/- 0,64 for nephroureterectomies and 240 min for quistectomia. The mean hospital stay was 3.18 min (2-6) days for nephrectomies; 5.91 (3-11) days for partial nephrectomies, 3 days (2-4) for nephroureterectomies and 6 days for the quistectomy. We had 8 complications (14%): 2 conversions for bledding and technical difficulty and 6 postoperative complications (3 were minor complications, postoperative fever and 3 mayor (2 Urinomas and one pseudoaneurism, requiring 2 interventions and one catheter double J placement). The evolution has been satisfactory in all cases. In the bibliographic review 47 articles with a level of evidence IIIB were selected (Oxford Centers for Evidence-based Medicine). The main reasons to conversion to open surgery were vascular problems and the complication rate change from anyone to 37%. CONCLUSIONS Laparoscopic surgery has proved to be a secure and feasible technique in the treatment of benign renal pathology in pediatric age with satisfactory results. Actually the indications are expanding to reconstructive procedures, with promising results, and selected oncologic procedures.
Collapse
|
17
|
Park YH, Kang MY, Jeong MS, Choi H, Kim HH. Laparoendoscopic single-site nephrectomy using a homemade single-port device for single-system ectopic ureter in a child: initial case report. J Endourol 2009; 23:833-5. [PMID: 19397431 DOI: 10.1089/end.2009.0025] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
A 3-year-old girl with a history of continuous urinary incontinence was found to have a right single-system ectopic ureter. She underwent laparoendoscopic single-site nephrectomy without any intraoperative or postoperative complications. To the best of our knowledge, this is the first case report of a laparoendoscopic single-site nephrectomy for single-system ectopic ureter in a child.
Collapse
Affiliation(s)
- Yong Hyun Park
- Department of Urology, Seoul National University Hospital, Korea
| | | | | | | | | |
Collapse
|
18
|
Abstract
Minimally invasive surgery (MIS) offers alternative operative approaches to standard open surgical techniques. However, MIS has been defined primarily as substituting laparoendoscopic alternatives for the traditional open surgical approach. The concept of MIS methodology may also be applied to open surgery in an effort to decrease incision size, potentially reduce morbidity and enhance convalescence, without compromising 'gold standard' outcomes. Pediatric urological applications of open MIS include pediatric renal surgery, ureteral reimplantation, ureteral surgery, inguinal-scrotal and genital surgery. A thorough review of the pediatric urology literature was performed and studies were identified describing open MIS, including outcomes and complications.
Collapse
|
19
|
Kim C, McKay K, Docimo SG. Laparoscopic Nephrectomy in Children: Systematic Review of Transperitoneal and Retroperitoneal Approaches. Urology 2009; 73:280-4. [PMID: 18952262 DOI: 10.1016/j.urology.2008.08.471] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2008] [Revised: 08/07/2008] [Accepted: 08/11/2008] [Indexed: 12/24/2022]
Affiliation(s)
- Christina Kim
- Department of Pediatric Urology, CT Children's Medical Center, Hartford, Connecticut 06106, USA.
| | | | | |
Collapse
|
20
|
Lee RS, Sethi AS, Passerotti CC, Retik AB, Borer JG, Nguyen HT, Peters CA. Robot Assisted Laparoscopic Partial Nephrectomy: A Viable and Safe Option in Children. J Urol 2009; 181:823-8; discussion 828-9. [DOI: 10.1016/j.juro.2008.10.073] [Citation(s) in RCA: 79] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2008] [Indexed: 11/26/2022]
Affiliation(s)
- Richard S. Lee
- Department of Urology, Children's Hospital Boston, Boston, Massachusetts
| | | | | | - Alan B. Retik
- Department of Urology, Children's Hospital Boston, Boston, Massachusetts
| | - Joseph G. Borer
- Department of Urology, Children's Hospital Boston, Boston, Massachusetts
| | - Hiep T. Nguyen
- Department of Urology, Children's Hospital Boston, Boston, Massachusetts
| | - Craig A. Peters
- Department of Urology, University of Virginia, Charlottesville, Virginia
| |
Collapse
|
21
|
Msezane LP, Mushtaq I, Gundeti MS. An update on experience with the single-instrument port laparoscopic nephrectomy. BJU Int 2008; 103:1406-8; discussion 1408-9. [PMID: 19021620 DOI: 10.1111/j.1464-410x.2008.08232.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To describe a modification of the posterior prone retroperitoneoscopic nephrectomy, which allows the entire operation to be performed through a single instrument port. PATIENTS AND METHODS With the patient prone, a retroperitoneal working space is created using a custom-made balloon lateral to the sacrospinalis muscle. One instrument port is placed at the tip of the 11th rib under direct vision. The laparoscope and working instrument can both be held by the operating surgeon. Gerota's fascia is incised and the kidney reflected anteriorly. The vessels are identified and divided. The remaining dissection is completed with a harmonic scalpel and the specimen is placed in an endo-catch bag. Care must be taken to avoid even minor bleeding, to keep the operating field clear. RESULTS The technique was successful in 54 children with a mean (range) age of 4.5 (0.25-14) years; the mean operative duration was 52 (35-96) min. Blood loss was minimal and there were no open conversions. Most children (51) were discharged the day after surgery, and the cosmetic outcome has been excellent in all cases. CONCLUSIONS Compared with the traditional approach, the single-instrument port laparoscopic (SImPL) nephrectomy approach avoids instrument crowding and maximizes the restricted retroperitoneal working space. Avoiding the second port might improve cosmesis and reduce cost. The technique is quickly mastered by both the experienced laparoscopist and trainee, and is feasible and safe.
Collapse
Affiliation(s)
- Lambda P Msezane
- Section of Paediatric Urology, University of Chicago, Chicago, IL, USA.
| | | | | |
Collapse
|
22
|
Yucel S, Brown B, Bush NC, Ahmad N, Baker LA. What to Anticipate With Experience in Pediatric Laparoscopic Ablative Renal Surgery. J Urol 2008; 179:697-702; discussion 702. [DOI: 10.1016/j.juro.2007.09.092] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2007] [Indexed: 10/22/2022]
Affiliation(s)
- Selcuk Yucel
- Departments of Urology, Akdeniz University School of Medicine, Antalya, Turkey (SY), and University of Texas Southwestern at Dallas and Children’s Medical Center at Dallas, Dallas, Texas
| | - Benjamin Brown
- Departments of Urology, Akdeniz University School of Medicine, Antalya, Turkey (SY), and University of Texas Southwestern at Dallas and Children’s Medical Center at Dallas, Dallas, Texas
| | - Nicol C. Bush
- Departments of Urology, Akdeniz University School of Medicine, Antalya, Turkey (SY), and University of Texas Southwestern at Dallas and Children’s Medical Center at Dallas, Dallas, Texas
| | - Naveed Ahmad
- Departments of Urology, Akdeniz University School of Medicine, Antalya, Turkey (SY), and University of Texas Southwestern at Dallas and Children’s Medical Center at Dallas, Dallas, Texas
| | - Linda A. Baker
- Departments of Urology, Akdeniz University School of Medicine, Antalya, Turkey (SY), and University of Texas Southwestern at Dallas and Children’s Medical Center at Dallas, Dallas, Texas
| |
Collapse
|
23
|
Chertin B, Ben-Chaim J, Landau EH, Koulikov D, Nadu A, Reissman P, Farkas A, Mor Y. Pediatric transperitoneal laparoscopic partial nephrectomy: comparison with an age-matched group undergoing open surgery. Pediatr Surg Int 2007; 23:1233-6. [PMID: 17899132 DOI: 10.1007/s00383-007-2005-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/21/2007] [Indexed: 10/22/2022]
Abstract
We have retrospectively evaluated the effectiveness of laparoscopic transperitoneal partial nephrectomy (LTPN) in children in comparison to an age-matched group of children who underwent open partial nephrectomy (OPN) in terms of safety, operative time, narcotic requirements and the length of hospitalization. All patients were divided into two groups. The first group of 10 children with a mean age of 3.6 +/- 1.3 years (mean +/- SEM) who underwent LTPN compared with an age and gender matched second group of 10 children with a mean age of 3.9 +/- 1.4 years who underwent OPN (P = 0.9119). In the first group, 5 upper poles and 5 lower poles partial nephrectomies were performed while in the second group 6 upper moieties and 4 lower moieties partial nephrectomies were performed, respectively. There was a single complication in each group. Intraoperative injury to the unaffected ureter was recognized during LTPN and required conversion to the open surgery in the beginning of learning curve and persistent urinary leakage from collecting system of the remnant pole in the OPN group, which resolved spontaneously. There was no difference in length of surgery and the intraoperative narcotic requirements (P = 0.8182, 0.7638, respectively). However, postoperative narcotic requirements were significantly lower in the first group 0.56 +/- 0.29 mg/kg compared to the second group 2.13 +/- 0.3 mg/kg, P = 0.0019. LTPN patients had significantly shorter hospitalization 2.7 +/- 0.29 days compared with the OPN group 5.1 +/- 0.64 days, P = 0.0039. Similar findings were also found in the subgroup of patients younger than 2 years. Median follow up in each group was 28 and 36 months, respectively. Our data show that LTPN is a safe and effective minimally invasive procedure at every age. It has an equivalent operative time, shorter hospitalization and lower postoperative narcotic requirements compared to the open approach.
Collapse
Affiliation(s)
- Boris Chertin
- The Section of Pediatric Urology, Israel Urological Association, Jerusalem, Israel.
| | | | | | | | | | | | | | | |
Collapse
|
24
|
Chacko JK, Koyle MA, Mingin GC, Furness PD. Minimally Invasive Open Renal Surgery. J Urol 2007; 178:1575-7; discussion 1577-8. [PMID: 17707048 DOI: 10.1016/j.juro.2007.05.099] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2007] [Indexed: 11/16/2022]
Abstract
PURPOSE Improved pediatric laparoscopic techniques and instruments have led to the increased popularity of laparoscopic pyeloplasty and nephrectomy at some centers. The recent trend has compared laparoscopic to open techniques to draw parallel conclusions from the adult literature that laparoscopic surgery in children offers the same advantages. Historically open renal surgery in the pediatric population has been done successfully but usually through more traumatic incisions. We present our experience with minimally invasive open renal surgery. MATERIALS AND METHODS A retrospective review of the last 6 years was performed of consecutive open pyeloplasties for ureteropelvic junction obstruction and open nephrectomy for multicystic dysplastic kidneys and renal duplication anomalies at a tertiary hospital for children. Parameters evaluated were patient age at surgery, surgical incision size, operative time, hospital stay and the need for postoperative narcotics. RESULTS A total of 135 patients underwent open renal surgery using an open retroperitoneal flank incision, including 66 younger than 1, 32 who were 1 to 5, 11 who were 5 to 10 and 26 who were older than 10 years. Mean +/- SD operative time was 101.4 +/- 44.7 minutes in patients younger than 1 year, 87.7 +/- 39.3 minutes in those 1 to 5 years old, 127.1 +/- 62.7 minutes in those 5 to 10 years old and 127.8 +/- 38.4 minutes in those older than 10 years. Incision size for the groups was 1.9 +/- 0.61, 1.9 +/- 0.72, 3.0 +/- 1.3 and 3.8 +/- 1.6 cm, respectively. The last 20 patients younger than 1 year who underwent open pyeloplasty had an incision of between 1 and 1.5 cm. Most incisions were performed through a posterior, subcostal muscle splitting approach. All patients received postoperative ketorolac. Supplemental narcotics were not required in any patients younger than 10 years. Of the patients 90% were discharged home in less than 23 hours. CONCLUSIONS The minimally invasive approach to open renal surgery is a safe and effective treatment choice in pediatric urology. The procedure can be easily performed through a small incision with minimal morbidity, comparable operative time and excellent cosmesis without excessive postoperative pain issues, allowing early discharge home. Perhaps this refined open surgery technique should be the benchmark for comparing new techniques.
Collapse
Affiliation(s)
- Job K Chacko
- Department of Pediatric Urology, Children's Hospital, University of Colorado Health Science Center, Denver, Colorado 80218, USA
| | | | | | | |
Collapse
|
25
|
Factor V Leiden mutation, in-utero inferior vena cava and renal vein thrombosis: report of successful retroperitoneoscopic nephrectomy. Case report No. 1. Eur Surg 2007. [DOI: 10.1007/s10353-007-0344-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
26
|
Basiri A, Simforoosh N, Heidari M, Moghaddam SH, Otookesh H. Laparoscopic v Open Donor Nephrectomy for Pediatric Kidney Recipients: Preliminary Report of a Randomized Controlled Trial. J Endourol 2007; 21:1033-6. [DOI: 10.1089/end.2006.0208] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- A. Basiri
- Department of Urology and Renal Transplantation, Urology and Nephrology Research Center (UNRC), Shahid Labbafi Nejad Hospital, Shahid Beheshti University of Medical Science, Tehran, Iran
| | - N. Simforoosh
- Department of Urology and Renal Transplantation, Urology and Nephrology Research Center (UNRC), Shahid Labbafi Nejad Hospital, Shahid Beheshti University of Medical Science, Tehran, Iran
| | - M. Heidari
- Department of Urology, UNRC, Lorestan University of Medical Sciences, Tehran, Iran
| | - S.M. Hosseini Moghaddam
- Departments of Infectious Diseases and Tropical Medicine, Urology and Nephrology Research Center (UNRC), Shahid Labbafi Nejad Hospital, Shahid Beheshti University of Medical Science, Tehran, Iran
| | - H. Otookesh
- Department of Nephrology, Ali Asghar children Hospital, Iran University of Medical Science, Tehran, Iran
| |
Collapse
|
27
|
Sundararajan L, Mohan PV, Chandran H. Horseshoe kidney: retroperitoneoscopic nephrectomy. J Pediatr Urol 2007; 3:159-61. [PMID: 18947725 DOI: 10.1016/j.jpurol.2006.07.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2005] [Accepted: 07/11/2006] [Indexed: 10/24/2022]
Abstract
The ideal approach for nephrectomy in the child with horseshoe kidney is debatable. We present two such children who underwent nephrectomy by a retroperitoneoscopic approach. Recognition of its anatomical variation is essential in the management of horseshoe kidney. Surgery is high risk, even using a traditional open procedure, because loss of the remaining half of the kidney is catastrophic.
Collapse
Affiliation(s)
- Lakshmi Sundararajan
- Department of Paediatric Surgery, Birmingham Children's Hospital NHS Trust, Steelhouse Lane, Birmingham B4 6NH, UK.
| | | | | |
Collapse
|
28
|
You D, Kim KS. Selection of Approach Method during Laparoscopic Renal Surgeries in Pediatric Patients. Korean J Urol 2007. [DOI: 10.4111/kju.2007.48.3.276] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Dalsan You
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Kun Suk Kim
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| |
Collapse
|
29
|
Jesch NK, Metzelder ML, Kuebler JF, Ure BM. Laparoscopic transperitoneal nephrectomy is feasible in the first year of life and is not affected by kidney size. J Urol 2006; 176:1177-9. [PMID: 16890720 DOI: 10.1016/j.juro.2006.04.049] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2005] [Indexed: 11/20/2022]
Abstract
PURPOSE We analyzed the feasibility of laparoscopic nephroureterectomy in children younger than 1 year, with regard to size of impaired kidney. MATERIALS AND METHODS A total of 40 consecutive children underwent transperitoneal laparoscopic nephrectomy during a 4-year period. Of the patients 19 (48%) were younger than 1 year and were analyzed in detail. Nine of these patients (47.4%) had a multicystic dysplastic kidney, 9 (47.4%) had reflux nephropathy and 1 (5.3%) had obstructive nephropathy. The duration of operation, reasons for conversion, and intraoperative and postoperative complications were prospectively documented. RESULTS Mean operative time was 133 minutes (range 60 to 240), and did not differ significantly between patients up to age 12 months compared to children 1 year and older (126 vs 148 minutes, NS). Nephroureterectomy was completed laparoscopically in 17 of 19 children (89%) up to age 12 months vs 20 of 21 (95%) 1 year and older (NS). In 1 child younger than 1 year suture dislocation at the renal artery required laparoscopic resuturing. No further complications were seen. In children younger than 1 year the mean operating time was not significantly different for resection of multicystic dysplastic kidney (8 patients, 113 minutes) compared to reflux nephropathy (9, 134 minutes, NS). Mean operating time did not differ significantly for kidney volumes less than 10 cc (8 patients, 119 minutes) compared to kidney volumes greater than 10 cc (9, 129 minutes, NS). CONCLUSIONS The feasibility of transperitoneal laparoscopic nephroureterectomy in children younger than 1 year is excellent. The duration of operation is not affected by patient age, underlying disease or kidney size.
Collapse
Affiliation(s)
- N K Jesch
- Department of Pediatric Surgery, Hannover Medical School, Carl-Neuberg-Strasse 1, 30625 Hannover, Germany
| | | | | | | |
Collapse
|
30
|
El-Ghoneimi A, Abou-Hashim H, Bonnard A, Verkauskas G, Macher MA, Huot O, Aigrain Y. Retroperitoneal laparoscopic nephrectomy in children: at last the gold standard? J Pediatr Urol 2006; 2:357-63. [PMID: 18947636 DOI: 10.1016/j.jpurol.2006.04.005] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2005] [Accepted: 04/12/2006] [Indexed: 10/24/2022]
Abstract
PURPOSE We analyzed our experience with retroperitoneal laparoscopic nephrectomy giving special attention to the learning curve, morbidity, and feasibility in a teaching institution. MATERIAL AND METHODS Between 1996 and 2004, we performed 104 laparoscopic nephrectomies in 88 children. Only four were performed via the transperitoneal approach, the others being via the retroperitoneal approach; the files of the latter were analyzed. Mean age was 5 years (20 days-15 years). Main indications were pretransplant nephrectomy for arterial hypertension, nephrotic syndrome or uremic hemolytic syndrome (51%), non-functioning kidney secondary to obstruction, reflux or ectopic ureter (38%), and multicystic dysplastic kidney (11%). Bilateral nephrectomy was performed in 13 children. RESULTS The lateral retroperitoneal approach was feasible in all cases even for those who had previous renal surgery. Conversion was not needed in any patient. No significant blood loss was observed. Mean operative time was 97 min (range 44-240) for unilateral nephrectomy; 46 nephrectomies were done in less than 90 min. In bilateral cases the mean operative time was 260 min (range 160-390). The operative time was less than 4 h in seven bilateral cases. Postoperative course was uneventful. Hospital stay was 1.9 days (range 1-3) for urological indications and 5 days (range 3-7) for patients with terminal renal disease. The procedure was initially performed by one surgeon, but was then expanded to other surgeons of the team, and safely taught to residents and fellows. CONCLUSIONS The procedure is safe, the learning curve is reasonable, teaching is feasible, operating time becomes with experience closer to open surgery without morbidity, and cosmetic results are excellent. This procedure may be considered as the gold standard for nephrectomy in children.
Collapse
Affiliation(s)
- Alaa El-Ghoneimi
- Department of Pediatric Surgery and Urology, University Hospital Robert Debre, AP-HP, University of Paris VII, 48 Boulevard Sérurier, 75019 Paris, France.
| | | | | | | | | | | | | |
Collapse
|
31
|
Tadini B, Repetto L, Guarino N, Lace R, Marras E, Bianchi M. Retroperitoneoscopic Renal Surgery in Children: Our Experience. J Laparoendosc Adv Surg Tech A 2006; 16:305-7. [PMID: 16796447 DOI: 10.1089/lap.2006.16.305] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Laparoscopic renal surgery has become an accepted approach for benign disease in adult and pediatric urology. We present our experience in renal laparoscopy in infants during the past 5 years and evaluate our series to establish the safety and efficacy of such procedures in children. MATERIALS AND METHODS From August 1999 to December 2004, we performed 32 renal laparoscopic procedures on 31 children aged 12 months to 16 years (mean, 42 months). Twenty-seven patients underwent unilateral retroperitoneal nephrectomy; 1 child with Denis Drash syndrome underwent transperitoneal bilateral nephrectomy; 2 children underwent renal cyst unroofing; and 1 child with lymphoma underwent retroperitoneal laparoscopic renal biopsy. Indications for surgery were: renal function <9% in cases of unilateral nephrectomy; the prevention of renal neoplastic changes in the patient with Denys-Drash syndrome; symptomatic large renal cysts; and suspected lymphoma not diagnosed with a previous percutaneous biopsy. RESULTS All procedures were completed laparoscopically. In 6 cases, the accidental opening of the peritoneum did not require conversion to open surgery. Intraoperative blood loss was minimal. One patient who underwent a retroperitoneal nephrectomy required a blood transfusion for postoperative bleeding into the retroperitoneal space. Twenty-four of 27 unilateral retroperitoneal nephrectomy patients were discharged on postoperative day 2. Mean follow-up was 30 months (range, 6-64 months). Cosmetic results were excellent in all patients and no long-term complications have been encountered so far. CONCLUSION Laparoscopic urologic surgery may be performed in children with minimal morbidity, minimal postoperative discomfort, improved cosmetic results, and a short hospital stay.
Collapse
Affiliation(s)
- Barbara Tadini
- Division of Pediatric Urology, OIRM Santa Anna, Torino, Italy.
| | | | | | | | | | | |
Collapse
|
32
|
Garg S, Gundeti M, Mushtaq I. The single instrument port laparoscopic (SIMPL) nephrectomy. J Pediatr Urol 2006; 2:194-6. [PMID: 18947608 DOI: 10.1016/j.jpurol.2005.07.008] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2005] [Accepted: 07/21/2005] [Indexed: 11/28/2022]
Abstract
AIMS To describe a novel modification of the posterior prone retroperitoneoscopic nephrectomy/nephroureterectomy which allows the entire procedure to be performed through a single instrument port. METHODS With the patient in a prone position, a retroperitoneal working space is created with the aid of a homemade balloon. A single instrument port is then placed at the tip of the 11th/12th rib under direct vision. Gerota's fascia is incised, the kidney is reflected anteriorly, and the hilar vessels are identified and divided. The ureter is mobilized as far distally as possible before division. The specimen is removed directly via the camera port or in an endobag. RESULTS We have employed this technique in 26 children with a high success rate. The median operating time was 58 (range 45-90) min. Blood loss was minimal in all cases and there were no complications. There have been no conversions and the cosmetic outcome has been excellent. Most of the children (24 of 26) were discharged home the day after surgery. CONCLUSIONS The single instrument port laparoscopic (SIMPL) nephrectomy is a feasible and safe technique for the experienced paediatric laparoscopic urologist.
Collapse
Affiliation(s)
- S Garg
- Department of Urology, Great Ormond Street Hospital for Children and Guy's Hospital, Great Ormond Street, London WC1N 3JH, UK
| | | | | |
Collapse
|
33
|
Ku JH, Byun SS, Choi H, Kim HH. Laparoscopic nephrectomy for congenital benign renal diseases in children: comparison with adults. Acta Paediatr 2005; 94:1752-5. [PMID: 16421035 DOI: 10.1111/j.1651-2227.2005.tb01849.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIM To compare the results of laparoscopic nephrectomy for congenital benign renal diseases in children and adults. METHODS From August 1996 to February 2003, laparoscopic nephrectomies were performed on 26 children and 60 adults. Of these patients, 33 patients (17 children, 16 adults) with comparable diseases were included in the analysis. RESULTS Disease was on the right side in 16 patients and on the left in 17. Operative and convalescence parameters, including operative time, blood loss, transfusion rate, conversion rate to open surgery, resumption of oral intake, hospital stay, and complication rate, were evaluated in both groups. Median operative time in the paediatric group was 140 min compared to 147.5 in adults (p=0.626). The estimated blood loss was significantly different (median 25 and 75 cm(3) in children and adults, respectively; p<0.001). Other operative and convalescence parameters were not statistically different. However, whereas no child required a blood transfusion, three adults (18.8%) did. No major perioperative complications occurred in the paediatric group, but open surgical exploration was needed due to retroperitoneal bleeding in a single adult. CONCLUSION Our findings indicate that laparoscopic nephrectomy for congenital benign disease in children is achieved safely and that the modality offers additional advantages in children as compared to adults.
Collapse
Affiliation(s)
- Ja Hyeon Ku
- Department of Urology, Seoul National University College of Medicine, Seoul, Korea
| | | | | | | |
Collapse
|
34
|
Lee RS, Retik AB, Borer JG, Diamond DA, Peters CA. Pediatric retroperitoneal laparoscopic partial nephrectomy: comparison with an age matched cohort of open surgery. J Urol 2005; 174:708-11; discussion 712. [PMID: 16006955 DOI: 10.1097/01.ju.0000164748.00339.4c] [Citation(s) in RCA: 94] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE We assessed the clinical usefulness of laparoscopic retroperitoneal partial nephrectomy (LRPN) in children by comparing an age matched cohort of pediatric patients undergoing open partial nephrectomy (OPN) to those undergoing LRPN for safety, efficacy, operative time, blood loss, inpatient narcotic use and length of hospitalization. MATERIALS AND METHODS A retrospective case-control study was performed of 1 group undergoing LRPN (treatment arm) and 1 undergoing OPN (controls) between 1997 and 2003. The 14 patients in each group were matched by age (mean 1.9 years in LRPN group vs 2.2 years in OPN group, p = 0.98) and gender. RESULTS All patients had duplication anomalies. Mean operative time was 194 minutes in the LRPN group and 193 minutes in the OPN group (p = 0.83). The single complication in the LRPN group was a urinoma that did not require intervention. There were no complications in OPN group. LRPN patients had a mean hospitalization of 1.7 days compared to 4.7 days in OPN patients (p = 0.001). Intraoperative narcotic requirements were higher in the LRPN group (0.59 vs 0.22 mg/kg, p = 0.04). Postoperative narcotic requirements were significantly less in the LRPN group (0.44 vs 1.53 mg/kg, p = 0.04). Similar findings were noted in a subanalysis of patients younger than 2 years. All patients had documented postoperative ipsilateral renal growth. Mean followups in the treatment and control groups were 26 and 25 months, respectively. CONCLUSIONS Retroperitoneal laparoscopic partial nephrectomy in small children was shown to be safe and effective. It had equivalent operative times, and decreased postoperative narcotics and hospitalization relative to the open approach, and, therefore, is a potentially advantageous technique.
Collapse
Affiliation(s)
- Richard S Lee
- Department of Urology, Children's Hospital Boston, Boston, Massachusetts 02115, USA
| | | | | | | | | |
Collapse
|
35
|
Buisson P, Leclair MD, Podevin G, Laplace C, Lejus C, Heloury Y. Chirurgie cœlioscopique chez l'enfant. Arch Pediatr 2005; 12:1407-10. [PMID: 15982860 DOI: 10.1016/j.arcped.2005.03.042] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2004] [Accepted: 03/03/2005] [Indexed: 11/22/2022]
Abstract
In the last two decades, laparoscopy surgery has been progressively adopted to children. Cardiorespiratory changes induced have been understood and controlled. Abdominal and urological surgery have widely benefited from this technique. Immediate postoperative period is simpler. The risk of small bowel obstruction by bands and adhesions is limited. Nevertheless, laparoscopy is not indicated for all pathologies. In neonatal surgery, more studies are necessary. Maybe the future is robotic surgery.
Collapse
Affiliation(s)
- P Buisson
- Service de chirurgie pédiatrique, hôpital de la mère et de l'enfant, quai Moncousu, 44093 Nantes cedex 01, France
| | | | | | | | | | | |
Collapse
|
36
|
Training in laparoscopic renal surgery, in a few weeks of intense exposure. J Pediatr Urol 2005; 1:295-9. [PMID: 18947555 DOI: 10.1016/j.jpurol.2005.01.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2004] [Accepted: 01/25/2005] [Indexed: 11/20/2022]
Abstract
OBJECTIVES Laparoscopic renal surgery has only recently become popular in the UK and, still, only a handful of pediatric urologists are offering the laparoscopic approach to their patients; therefore, there are only limited places available for training in this discipline. In this institution, which is a major tertiary referral center for pediatric urology having four consultants, one urologist specializes in laparoscopic renal surgery and about 50 laparoscopic ablative renal surgical procedures are performed annually. The aim of this study was to determine the effectiveness of the training provided, for three trainees, in light of the complexity of the ablative procedures performed. PATIENTS AND METHODS Patients who required laparoscopic ablative renal surgery from June 2003 to May 2004 were identified from the prospectively maintained database and data were analyzed. During this period of 12 months, 49 operations have been performed laparoscopically. There were three trainees, A, B and C, who joined the mentor, at different times, for a continuous period of 6, 12 and 6 weeks, respectively. The training was one to one and, at an appropriate level of expertise, the trainees were allowed to perform operations independently; they continued to do so after returning to their units. RESULTS There were 22 males and 27 females, age ranging from 8 months to 16 years (mean 3.6 years). There were 25 nephrectomies, 23 via the prone retroperitoneal (PRP) approach and two via the transperitoneal (TP) approach; the mean time taken was 70 min. There were 12 nephroureterectomies, six via the PRP, three via the TP, and the other three via the lateral retroperitoneal (LRP) approach; the mean time taken was 100 min. There were 10 heminephroureterectomies (six upper pole and four lower pole), six via the PRP, three via the TP and one via the LRP approach; the mean time taken was 160 min. Of two bilateral nephrectomies one was via the PRP and one the TP approach, and the mean time taken was 170 min. The mean time to discharge for nephrectomy was 7 h, and for nephroureterectomy, heminephroureterectomy and bilateral nephrectomy 21, 23 and 43 h, respectively. Trainee A had been in pediatric surgery for 4 years and during a period of 6 weeks he assisted in five operations, but did not get the opportunity to perform independently. Trainee B had been in pediatric surgery for 13 years and during a period of 12 weeks he assisted in nine operations and performed three. Trainee C had been in pediatric surgery for 20 years and during a period of 6 weeks he assisted in five operations and performed one. Since returning to their overseas units, trainee B and trainee C have successfully performed two nephrectomies each. CONCLUSION Retroperitoneoscopic renal surgery is within the grasp of any experienced urologist or urology trainee. With intensive exposure and one-to-one mentoring, 6-12 weeks would be sufficient to achieve adequate competence and confidence to perform a prone retroperitoneoscopic nephrectomy.
Collapse
|
37
|
Current World Literature. Curr Opin Urol 2005. [DOI: 10.1097/01.mou.0000160630.81978.ac] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|