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Molinaro F, Nascimben F, Todesco C, Fusi G, Chiarella E, Planchamp T, Cobellis G, Abbo O, Messina M, Angotti R. Robotic approach to the uretero-vesical junction in children: An international multicentric retrospective study. Int J Med Robot 2023; 19:e2539. [PMID: 37260098 DOI: 10.1002/rcs.2539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 05/17/2023] [Accepted: 05/22/2023] [Indexed: 06/02/2023]
Abstract
BACKGROUND Robot-assisted approach to UVJ is getting more and more used in pediatric patients. METHODS In this retrospective study 26 patients affected by nephro-urological malformations, robotic-surgically treated from 2016 and 2021 at 3 Pediatric Surgery Department were included: 3 (11.5%) primary obstructive megaureter, 2 (7.7%) dysplastic kidneys, 3 (11.5%) duplex collecting system, 18 (69.2%) primary vescico-ureteral reflux (VUR). RESULTS Mean age at surgery was 6 years old. 22 (84.6%) underwent Lich Gregoire extravesical ureteral reimplantation, 4 (15.4%) total nephroureterectomy. Mean operative time was 230 min. No conversions or intraoperative complications. Median hospital stay was 4 days. There were 4 (15.38%) postoperative complications: 3 (11.54%) persistent VUR and 1 (3.84%) refluxing megaureter. 2 (7.7%) redo-surgery. CONCLUSIONS Robotic Surgery should be considered a safe and effective technique for treatment of UVJ anomalies in children, because it firstly allows surgeons to approach both upper and lower ureteral ends without modifying trocars' placement.
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Affiliation(s)
- Francesco Molinaro
- Department of Medical Sciences, Surgery and Neuroscience, Section of Pediatric Surgery, University of Siena, Siena, Italy
| | - Francesca Nascimben
- Department of Medical Sciences, Surgery and Neuroscience, Section of Pediatric Surgery, University of Siena, Siena, Italy
| | - Camilla Todesco
- Department of Medical Sciences, Surgery and Neuroscience, Section of Pediatric Surgery, University of Siena, Siena, Italy
- Pediatric Surgery, Salesi Children Hospital, Università Politecnica Delle Marche, Ancona, Italy
| | - Giulia Fusi
- Department of Medical Sciences, Surgery and Neuroscience, Section of Pediatric Surgery, University of Siena, Siena, Italy
- Service de Chirurgie Pédiatrique, Hôpital des Enfants, Toulouse, France
| | - Elisa Chiarella
- Department of Medical Sciences, Surgery and Neuroscience, Section of Pediatric Surgery, University of Siena, Siena, Italy
| | | | - Giovanni Cobellis
- Pediatric Surgery, Salesi Children Hospital, Università Politecnica Delle Marche, Ancona, Italy
| | - Olivier Abbo
- Service de Chirurgie Pédiatrique, Hôpital des Enfants, Toulouse, France
| | - Mario Messina
- Department of Medical Sciences, Surgery and Neuroscience, Section of Pediatric Surgery, University of Siena, Siena, Italy
| | - Rossella Angotti
- Department of Medical Sciences, Surgery and Neuroscience, Section of Pediatric Surgery, University of Siena, Siena, Italy
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Zhang J, Gao L, Li C, Yang X, Lei Y, Liu C. Laparoscopy combining with ureteroscopy for horseshoe kidney accompanying with duplicate kidney and a ureteral calculus: a case report. BMC Urol 2020; 20:95. [PMID: 32652967 PMCID: PMC7353682 DOI: 10.1186/s12894-020-00667-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Accepted: 07/06/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Horseshoe kidney (HSK) is a common renal fusion anomaly, occurring in about 1 in 400-600 individuals. In addition, the incidence of duplicated collecting system is about 0.8%. CASE PRESENTATION This report documents an extremely rare case, which was treated by multiple procedures in the same operative session to accomplish laparoscopic amputation of the HSK isthmus, resection of duplicate kidney and ureteroscopic lithotripsy. CONCLUSION Results showed that minimally invasive surgery with use of multiple endoscopes may be a feasible choice for this patient population with complicated comorbid renal conditions.
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Affiliation(s)
- Jindong Zhang
- Department of Urology, the Second Affiliated Hospital of Chongqing Medical University, Chongqing, 400000, China
| | - Liang Gao
- Department of Urology, the Second Affiliated Hospital of Chongqing Medical University, Chongqing, 400000, China
| | - Changlong Li
- Department of Urology, the Second Affiliated Hospital of Chongqing Medical University, Chongqing, 400000, China
| | - Xiaokang Yang
- Department of Urology, the Second Affiliated Hospital of Chongqing Medical University, Chongqing, 400000, China
| | - Yusheng Lei
- Department of Urology, the Second Affiliated Hospital of Chongqing Medical University, Chongqing, 400000, China
| | - Chuan Liu
- Department of Urology, the Second Affiliated Hospital of Chongqing Medical University, Chongqing, 400000, China.
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Masieri L, Sforza S, Cini C, Escolino M, Grosso A, Esposito C, Minervini A, Carini M. Minilaparoscopic Versus Open Pyeloplasty in Children Less Than 1 Year. J Laparoendosc Adv Surg Tech A 2019; 29:970-975. [DOI: 10.1089/lap.2018.0586] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Affiliation(s)
- Lorenzo Masieri
- Paediatric Urology Unit, Meyer Children Hospital, University of Florence, Florence, Italy
- Department of Urology, Careggi Hospital, University of Florence, Florence, Italy
| | - Simone Sforza
- Paediatric Urology Unit, Meyer Children Hospital, University of Florence, Florence, Italy
- Department of Urology, Careggi Hospital, University of Florence, Florence, Italy
| | - Chiara Cini
- Paediatric Urology Unit, Meyer Children Hospital, University of Florence, Florence, Italy
| | - Maria Escolino
- Paediatric Surgery Unit, Federico II Hospital, University of Neaples, Naples, Italy
| | - Antonio Grosso
- Paediatric Urology Unit, Meyer Children Hospital, University of Florence, Florence, Italy
- Department of Urology, Careggi Hospital, University of Florence, Florence, Italy
| | - Ciro Esposito
- Paediatric Surgery Unit, Federico II Hospital, University of Neaples, Naples, Italy
| | - Andrea Minervini
- Department of Urology, Careggi Hospital, University of Florence, Florence, Italy
| | - Marco Carini
- Department of Urology, Careggi Hospital, University of Florence, Florence, Italy
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Chen DX, Wang ZH, Wang SJ, Zhu YY, Li N, Wang XQ. Retroperitoneoscopic approach for partial nephrectomy in children with duplex kidney: A case report. World J Clin Cases 2019; 7:1169-1176. [PMID: 31183349 PMCID: PMC6547330 DOI: 10.12998/wjcc.v7.i10.1169] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Revised: 03/16/2019] [Accepted: 03/26/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Renal duplication is a common deformity of the urinary system, with an incidence of approximately 1/125 in children. Symptomatic patients with hydronephrosis, vesicoureteral reflux, or incontinence may require surgical interventions. Laparoscopy and retroperitoneoscopy are the two main accesses for partial nephrectomy.
CASE SUMMARY A 9-year-old child was admitted to the hospital for hydronephrosis of the left kidney. Ultrasonography showed that the left kidney was larger, approximately 12.6 cm × 6.3 cm × 5.5 cm in size, with visible separation of the pelvis and an obviously separated lower portion. The upper segment of the left ureter was dilated (approximately 2.6 cm in width), and no significant dilation was observed in the middle and upper segments. The right kidney and ureter were normal. Primary diagnosis was left renal duplication malformation and hydronephrosis. Retroperitoneal laparoscopic nephrectomy and ureterectomy were performed. Intraoperative exploration revealed a dilated pelvis and thin renal parenchyma at the lower pole of the left kidney. The upper left kidney was smaller than normal, and the pelvis and ureter were larger than normal. The renal artery was blocked for 40 min. A hemolock was used to clamp down the kidney ureter, and a drainage tube was retained in the retroperitoneal cavity. The operation was uneventful, and the estimated amount of blood loss was 100 mL. Total abdominal drainage amount was 116 mL. The drainage tube was removed on postoperative day (POD) 3 and the patient was discharged on POD6. The pathological diagnosis confirmed the atrophy of the renal parenchyma, the dilation of the renal pelvis, hydronephrosis, and ureteral cystic dilation.
CONCLUSION The retroperitoneoscopic approach for partial nephrectomy is feasible and effective in selective pediatric patients with a duplex kidney.
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Affiliation(s)
- Di-Xiang Chen
- Department of Pediatrics, PLA General Hospital, Beijing 100853, China
| | - Zi-Hao Wang
- The Fourth Military Medical University, Xi’an 710032, Shannxi Province, China
| | - Shan-Jie Wang
- The Sixth People’s Hospital of Jinan Affiliated to Jining Medical School, Jinan 250200, Shandong Province, China
| | - Yue-Yue Zhu
- Southern Medical University, Guangzhou 510515, Guangdong Province, China
| | - Nan Li
- Department of Ultrasound Diagnosis, PLA General Hospital, Beijing 100853, China
| | - Xian-Qiang Wang
- Department of Pediatrics, PLA General Hospital, Beijing 100853, China
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5
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Singh M, Agarwal S, Goel A, Kumar M, Sharma A, Pandey S, Sankhwar S. Laparoscopic transperitoneal heminephrectomy for treatment of the nonfunctioning moiety of duplex kidney in adults: A case series. Investig Clin Urol 2019; 60:210-215. [PMID: 31098429 PMCID: PMC6495031 DOI: 10.4111/icu.2019.60.3.210] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Accepted: 02/14/2019] [Indexed: 11/18/2022] Open
Abstract
Purpose We report the results and experience of a tertiary care center in laparoscopic transperitoneal heminephrectomy for the treatment of a non-functioning upper pole moiety of duplex kidney in adults. Materials and Methods The key point of the technique included the placement of a 6-Fr ureteric catheter in the healthy ureter at the beginning of the procedure under fluoroscopic guidance cystoscopically. A standard laparoscopic 3- to 4-port placement was done after placing the patient in a 45 to 90 degrees lateral decubitus position. The upper pole was mobilized transperitoneally and transected using a harmonic scalpel. Results A total of 17 patients aged 19 to 44 years underwent laparoscopic upper pole heminephrectomy. All patients had a complete duplicated renal collecting system on the ipsilateral side. Three patients were found to have ureterocele. The average blood loss was minimal (50–150 mL) with a mean of 95 ml. None of the patients required any blood transfusions. The mean operative time was 220 minutes (range, 160–315 minutes). The average length of hospital stay was 3 days (range, 2–4 days). Only 2 patients had Clavien-Dindo grade 3a complications, which were managed by double J stenting and percutaneous aspiration, respectively. Conclusions Laparoscopic heminephrectomy is playing a cornerstone role in the treatment of the non-functioning moiety of duplex kidneys. The procedure is safe, efficient and offers the typical preoperative and postoperative benefits of laparoscopic surgery. The rate of complications in adults is acceptable and is similar to that reported in pediatric patients.
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Affiliation(s)
- Manmeet Singh
- Department of Urology, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Samarth Agarwal
- Department of Urology, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Apul Goel
- Department of Urology, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Manoj Kumar
- Department of Urology, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Ashish Sharma
- Department of Urology, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Siddharth Pandey
- Department of Urology, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Satynarayan Sankhwar
- Department of Urology, King George's Medical University, Lucknow, Uttar Pradesh, India
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Rogatko CP, Berent AC, Adams LG, Weisse CW, Bagley D. Endoscopic laser-ablation for the treatment of orthotopic and ectopic ureteroceles in dogs: 13 cases (2008-2017). J Vet Intern Med 2019; 33:670-679. [PMID: 30740771 PMCID: PMC6430922 DOI: 10.1111/jvim.15424] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Accepted: 01/11/2019] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Ureteroceles are a rare condition in dogs in which conventional treatments can result in substantial morbidity. Cystoscopic and fluoroscopic-guided laser ablation (CLA) of ureteroceles can successfully relieve obstruction. OBJECTIVES To describe the technique and outcomes of attempting CLA for treatment of ureteroceles in dogs. ANIMALS Thirteen client-owned dogs that underwent CLA for treatment of ureteroceles. METHODS Retrospective multicentered study. Medical records were reviewed in all dogs that underwent CLA for ureterocele(s). A laser was used to extend the opening of the ureteral orifice (UO) unless surgical conversion was necessary. Data collected included signalment, clinicopathologic data, imaging, procedural findings, complications, and short- and long-term outcome. RESULTS Thirteen dogs with 13 ureteroceles associated with 14 UOs resulting in ureteral obstruction were included. One ureterocele extended bilaterally. Treatment was initiated via retrograde cystoscopy (7 females), percutaneous perineal urethrocystoscopy (4 males), or percutaneous antegrade cystoscopy (2 males). Surgical conversion was necessary in 2 males. Ten of 14 (71%) UOs associated with the ureteroceles were ectopic. Thirteen of 14 had stenotic or imperforate UOs. No postoperative complications were noted. Preoperative incontinence or pollakiuria was present in 9 of 13 and 3 of 13 dogs and resolved in 8 of 9 and 3 of 3 dogs, respectively. Follow-up imaging showed resolution of all ureteroceles and improved ureteral/renal pelvic dilatation. Median follow-up time was 27 months (range, 3-96 months). CONCLUSIONS AND CLINICAL IMPORTANCE Cystoscopic-guided laser ablation was effective for the treatment of ureteroceles(s) in 11 of 13 dogs.
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Affiliation(s)
- Cleo P Rogatko
- Department of Interventional Radiology/Interventional Endoscopy, The Animal Medical Center, New York, New York
| | - Allyson C Berent
- Department of Interventional Radiology/Interventional Endoscopy, The Animal Medical Center, New York, New York
| | - Larry G Adams
- Department of Veterinary Clinical Sciences, Purdue University College of Veterinary Medicine, West Lafayette, Indiana
| | - Chick W Weisse
- Department of Interventional Radiology/Interventional Endoscopy, The Animal Medical Center, New York, New York
| | - Demetrius Bagley
- Department of Urology, Jefferson Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
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MacDonald C, Small R, Flett M, Cascio S, O'Toole S. Predictors of complications following retroperitoneoscopic total and partial nephrectomy. J Pediatr Surg 2019; 54:331-334. [PMID: 30502005 DOI: 10.1016/j.jpedsurg.2018.10.097] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2018] [Accepted: 10/30/2018] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Recent reports in the literature suggest an increased risk of complications with retroperitoneal as opposed to transperitoneal approach to partial nephrectomy (PN) and total nephrectomy (TN). We are a large unit performing predominantly retroperitoneoscopic PN and TN. We aim to review our outcomes and perform analysis to elucidate the predictors of complications following the retroperitoneal approach for extirpative kidney surgery. METHODS We performed a single center retrospective review of children undergoing MIMS TN and PN between 2005 and 2015. Variables were tested for association with outcomes using Chi2 and Spearman's Rho correlation. RESULTS We performed 173 MIMS nephrectomies, 119 total and 54 partial. Median age and weight were 5 years (6 months to 18 years) and 24.9 kg (7.7 to 85 kg) and operative time 147 min. There were 4 conversions and 17 postoperative complications. 19.6% children required further surgery, including 8 completion stumpectomies. Retroperitoneal approach did not have increased risk compared to transperitoneal for need of further surgery. Partial nephrectomy was not associated with higher rate of intraoperative complication or LOS. Predictors of intraoperative complication were vessel closure technique. Associations with need for further surgery were: ESRF, contralateral disease, bladder dysfunction, presence of PD catheter, and need for concomitant procedure. CONCLUSION Our conversion rate (1.9%) and need for further surgery (13.1%) following the retroperitoneal approach to the kidney are favorable to the literature. Need for reoperation is often associated with the underlying diagnosis and the natural sequelae of the disease process. LEVEL OF EVIDENCE IV.
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Affiliation(s)
| | - Robert Small
- The Royal Hospital for Children, Glasgow, Scotland
| | - Martyn Flett
- The Royal Hospital for Children, Glasgow, Scotland
| | | | - Stuart O'Toole
- The Royal Hospital for Children, Glasgow, Scotland. Stuart.O'
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Galganski LA, Hirose S, Saadai P. Resection of a thoracoabdominal ganglioneuroma via a retroperitoneal minimally invasive approach. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2018; 40:47-49. [PMID: 31745453 PMCID: PMC6863619 DOI: 10.1016/j.epsc.2018.10.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
A 10-year-old girl presented to her pediatrician with a history of cough and fever. A chest radiograph revealed a paraspinal mass. On cross-sectional imaging, the mass traversed the diaphragm, extending from T9 to L1 spinal levels with involvement of the T10–12 neural foramen. Vanillylmandelic and homovanillic acid levels were normal. On review of historical radiographs, the mass had increased in size. Thus, surgical resection was recommended for diagnosis and treatment. The patient was placed in left lateral decubitus position. The retroperitoneal space was accessed inferior to the twelfth rib. One 12 mm and two 5 mm ports were used. Development of the retroperitoneal space was achieved with both blunt dissection and a vessel-sealing device. The diaphragm was incised to resect the thoracic component of the mass. The tumor was adherent at the neural foramen and was resected flush with the spine. The diaphragm repaired primarily. She was discharged home on post-operative day four without complication. Pathology demonstrated a ganglioneuroma. The patient was well at her follow-up, and imaging one year postoperatively was without recurrence. No additional treatment was required. A laparoscopic retroperitoneal approach allows for a safe, minimally invasive resection of a thoracoabdominal mass without violation of the abdominal cavity.
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Affiliation(s)
- Laura A Galganski
- University of California - Davis, Division of Pediatric General, Thoracic and Fetal Surgery, USA
| | - Shinjiro Hirose
- University of California - Davis, Division of Pediatric General, Thoracic and Fetal Surgery, USA
| | - Payam Saadai
- University of California - Davis, Division of Pediatric General, Thoracic and Fetal Surgery, USA
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Escolino M, Riccipetitoni G, Yamataka A, Mushtaq I, Miyano G, Caione P, Chiarenza F, Borzi P, Esposito C. Retroperitoneoscopic partial nephrectomy in children: a multicentric international comparative study between lateral versus prone approach. Surg Endosc 2018; 33:832-839. [PMID: 30006841 DOI: 10.1007/s00464-018-6349-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2018] [Accepted: 07/06/2018] [Indexed: 01/15/2023]
Abstract
BACKGROUND Very limited informations are currently available about the best approach to perform retroperitoneoscopic surgery. This multicentric international study aimed to compare the outcome of lateral versus prone approach for retroperitoneoscopic partial nephrectomy (RPN) in children. METHODS The records of 164 patients underwent RPN in 7 international centers of pediatric surgery over the last 5 years were retrospectively reviewed. Sixty-one patients (42 girls and 19 boys, average age 3.8 years) were operated using lateral approach (G1), whereas 103 patients (66 girls and 37 boys, average age 3.0 years) underwent prone RPN (G2). The two groups were compared in regard to operative time, postoperative outcome, postoperative complications, and re-operations. RESULTS The average operative time was significantly shorter in G2 (99 min) compared to G1 (160 min) (p = 0.001). Only 2 lateral RPN required conversion to open surgery. There was no significant difference between the two groups as for intraoperative complications (G1:2/61, 3.3%; G2:6/103, 5.8%; p = 0.48), postoperative complications (G1:9/61, 14.7%; G2:17/103, 16.5%; p = 0.80), and re-operations (G1:2/61, 3.3%; G2:4/103, 3.8%; p = 0.85). Regarding postoperative complications, the incidence of symptomatic residual distal ureteric stumps (RDUS) was significantly higher in G2 (7/103, 6.8%) compared to G1 (1/61, 1.6%) (p = 0.001). Most re-operations (4/6, 66.6%) were performed to remove a RDUS . CONCLUSIONS Both lateral and prone approach are feasible and reasonably safe to perform RPN in children but the superiority of one approach over another is not still confirmed. Although prone technique resulted faster compared to lateral approach, the choice of the technique remains dependent on the surgeon's personal preference and experience. Our results would suggest that the lateral approach should be preferred to the prone technique when a longer ureterectomy is required, for example in cases of vesico-ureteral reflux into the affected kidney moiety, in order to avoid to leave a long ureteric stump that could become symptomatic and require a re-intervention.
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Affiliation(s)
- Maria Escolino
- Division of Pediatric Surgery, Federico II University of Naples, Via Pansini 5, 80131, Naples, Italy
| | | | - Atsuyuki Yamataka
- Division of Pediatric Urogenital Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Imran Mushtaq
- Division of Pediatric Urology, Great Ormond Street Hospital, London, UK
| | - Go Miyano
- Division of Pediatric Urogenital Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Paolo Caione
- Division of Pediatric Urology, Bambino Gesù Children Hospital, Rome, Italy
| | - Fabio Chiarenza
- Division of Pediatric Surgery, San Bortolo Hospital, Vicenza, Italy
| | - Peter Borzi
- Division of Pediatric Surgery, Mater and Royal Children's Hospitals, Brisbane, Australia
| | - Ciro Esposito
- Division of Pediatric Surgery, Federico II University of Naples, Via Pansini 5, 80131, Naples, Italy.
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Cerulo M, Escolino M, Turrà F, Roberti A, Farina A, Esposito C. Benefits of Retroperitoneoscopic Surgery in Pediatric Urology. Curr Urol Rep 2018; 19:33. [DOI: 10.1007/s11934-018-0777-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Abstract
Retroperitoneoscopic heminephrectomy has multiple potential benefits in both infants and children. This article reviewed technical aspects of the procedure, and provided illustrations and an operative video demonstration. The vital first step is a 'critical view' of the collecting system/vascular supply of both upper/lower moieties. Dividing the lateral renal attachments later in the dissection allows passive retraction of the hilum, facilitating this dissection.
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12
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Varda BK, Cho P, Wagner AA, Lee RS. Collaborating with our adult colleagues: A case series of robotic surgery for suspicious and cancerous lesions in children and young adults performed in a free-standing children's hospital. J Pediatr Urol 2018; 14:182.e1-182.e8. [PMID: 29503221 PMCID: PMC5970046 DOI: 10.1016/j.jpurol.2018.01.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Accepted: 01/03/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND In adult urologic oncology the use of robotics has become commonplace; in pediatric urology it is rare. Herein, we describe a collaboration between an adult and a pediatric urologist performing robotic surgery for children and young adults with suspicious or cancerous genitourinary (GU) lesions. OBJECTIVES To evaluate clinical and oncologic outcomes in children and young adults undergoing robotic surgery for suspicious or cancerous lesions of the GU tract; to describe our collaborative model between an adult and pediatric surgeon at a free-standing children's hospital. DESIGN We retrospectively reviewed all robotic cases performed at our institution from 2014 to 2016 for patients with a GU malignancy or a suspicious mass. The surgeries were performed by a pediatric urologist with robotic experience and a fellowship-trained MIS adult urologist specializing in oncology. Perioperative and oncologic outcomes were recorded. RESULTS A total of eight robotic cases were performed: four partial nephrectomies (PN) with retroperitoneal lymph node dissection (LND) (OT 269-338 min, EBL 5-300 mL, LOS 3-6 days), one adrenalectomy with LND (6.4 cm mass; OT 172 min, EBL 5 mL, LOS 3 days), one nephrectomy with pericaval LND (9.8 cm mass; 234 min, EBL 25 mL, LOS 3 days), and two retroperitoneal LNDs (OT 572 and 508 min, EBL 250 and 100, LOS 3 and 4 days). Patient weights ranged from 14 to 79 kg (mean 53.4 kg). There were no major complications (Clavien 3-5). Pathology results for PN included papillary RCC (AJCC pT1aNx) and two cases of segmental cystic renal dysplasia with nephrogenic rests. Bilateral template RPLNDs yielded paratesticular rhabdomyosarcoma (43 nodes; COG low risk group II stage I) and mixed non-seminomatous germ cell tumor (74 nodes; COG stage III). The nephrectomy yielded an undifferentiated sarcoma, low grade; the adrenalectomy favorable-type ganglioneuroma. DISCUSSION In pediatrics, urologic oncology cases are often managed with open surgery. Our series demonstrates the feasibility of using the robotic approach in carefully selected cases. In doing so, the patient benefits from a minimally invasive surgery, while the surgeon benefits from robotic surgical dexterity. We seamlessly advanced these new techniques through a step-wise collaboration between an adult urologist who routinely performs robotic oncology procedures and a pediatric urologist experienced in robotics for benign conditions. CONCLUSION In this small series, we safely and effectively adapted adult robotic techniques for genitourinary oncology cases in children and young adults.
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Affiliation(s)
- Briony K Varda
- Boston Children's Hospital, Department of Urology, Harvard Medical School, Boston, MA, USA.
| | - Patricia Cho
- Boston Children's Hospital, Department of Urology, Harvard Medical School, Boston, MA, USA
| | - Andrew A Wagner
- Beth Israel Deaconess Medical Center, Department of Urology, Harvard Medical School, Boston, MA, USA
| | - Richard S Lee
- Boston Children's Hospital, Department of Urology, Harvard Medical School, Boston, MA, USA
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Clement K, Hendry J, Keeley FX, Aboumarzouk OM. Heminephrectomy in Adults: A Systematic Review with Cumulative Analysis. Urol Int 2017; 101:1-6. [PMID: 29224026 DOI: 10.1159/000485466] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Accepted: 11/17/2017] [Indexed: 12/26/2022]
Abstract
INTRODUCTION Duplex collecting system of the kidney is a relatively common abnormality, with the majority of symptomatic cases discovered in childhood. Treatment is commonly a heminephrectomy of the affected moiety. We aimed to conduct a systematic review of the literature to provide the best available evidence for heminephrectomy for duplex kidneys in the adult population. MATERIALS AND METHODS A literature search was conducted in September 2017 with no limitations being placed on language, region, date or publication type. Data were represented numerically and analysed cumulatively. RESULTS Seven retrospective studies with 66 patients were included. Of which, 56/66 operations were performed laparoscopically, 5/66 were robot-assisted and 5/66 were open procedures. Complete resolution of symptoms was reported in 53/55 (96.4%) of patients in five studies providing outcome data. Of the 6 studies reporting complications, there were a total of 9 complications (9/62, 14.5%), however 5 of these were found to be in one study alone. CONCLUSIONS This review emphasises the scarcity of evidence for heminephrectomy in adults. Nonetheless, it has been shown that this operation may be effective in alleviating patients' symptoms in addition to being safe in experienced hands.
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Affiliation(s)
- Keiran Clement
- Department of Urology, Glasgow Urological Research Unit, Queen Elizabeth University Hospital, Glasgow, United Kingdom
| | - Jane Hendry
- Department of Urology, Glasgow Urological Research Unit, Queen Elizabeth University Hospital, Glasgow, United Kingdom
| | - Francis X Keeley
- Bristol Urological Institute, Southmead Hospital, Bristol, United Kingdom
| | - Omar M Aboumarzouk
- Department of Urology, Glasgow Urological Research Unit, Queen Elizabeth University Hospital, Glasgow, United Kingdom.,University of Glasgow, School of Medicine, Dentistry and Nursing, Glasgow, United Kingdom.,Islamic Universities of Gaza, College of Medicine, Gaza, Palestina
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Ballouhey Q, Binet A, Clermidi P, Braik K, Villemagne T, Cros J, Lardy H, Fourcade L. Partial nephrectomy for small children: Robot-assisted versus open surgery. Int J Urol 2017; 24:855-860. [PMID: 29027269 DOI: 10.1111/iju.13466] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Accepted: 08/25/2017] [Indexed: 12/26/2022]
Abstract
OBJECTIVES To compare the outcomes of robot-assisted heminephrectomy for duplex kidney in children with those of open heminephrectomy. METHODS The present retrospective multicentric analysis reviewed the records of robot-assisted versus open heminephrectomy carried out for duplex kidney in children from 2007 to 2014. Demographic data, weight, surgical time, hospital stay, complications and outcome were recorded. Follow up was based on a clinical review, renal sonography and dimercaptosuccinic acid renal scintigraphy. RESULTS A total of 15 patients underwent robot-assisted heminephrectomy, and 13 patients underwent retroperitoneal heminephrectomy by open approach. All patients weighed <15 kg. The mean age at the time of surgery was 20.2 months (range 7-39 months) in the robotic group, and 18.4 months (range 6-41 months) in the open group. The mean hospital stay was statistically longer for the open surgery group (6.3 days, range 5-8 days vs 3.4 days, range 1-7 days; P < 0.001). Regarding postoperative pain control, total morphine equivalent intake was statistically greater for the open group (0.52 mg/kg/day vs 1.08 mg/kg/day; P < 0.001). No patient lost the remaining healthy moiety. There was no significant difference in terms of operating time, complication rate or renal outcomes. CONCLUSIONS Robot-assisted heminephrectomy in small children seems to offer comparable renal outcomes with those of its standard open surgery counterpart. Specific technical adjustments are necessary, which typically increase the set-up time.
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Affiliation(s)
- Quentin Ballouhey
- Department of Pediatric Surgery, Limoges University Hospital, Limoges, France
| | - Aurélien Binet
- Department of Pediatric Surgery, Tours University Hospital, Tours, France
| | - Pauline Clermidi
- Department of Pediatric Surgery, Limoges University Hospital, Limoges, France
| | - Karim Braik
- Department of Pediatric Surgery, Tours University Hospital, Tours, France
| | - Thierry Villemagne
- Department of Pediatric Surgery, Tours University Hospital, Tours, France
| | - Jérôme Cros
- Department of Pediatric Anesthesiology, Limoges University Hospital, Limoges, France
| | - Hubert Lardy
- Department of Pediatric Surgery, Tours University Hospital, Tours, France
| | - Laurent Fourcade
- Department of Pediatric Surgery, Limoges University Hospital, Limoges, France
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Hong YH, DeFoor WR, Reddy PP, Schulte M, Minevich EA, VanderBrink BA, Noh PH. Hidden incision endoscopic surgery (HIdES) trocar placement for pediatric robotic pyeloplasty: comparison to traditional port placement. J Robot Surg 2017; 12:43-47. [DOI: 10.1007/s11701-017-0684-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Accepted: 02/12/2017] [Indexed: 12/19/2022]
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Gözen AS, Badawy H, Teber D, Assem A, Rassweiler J. Outcome of laparoscopic upper pole heminephroureterectomy in children: A two-centre experience. Arab J Urol 2016; 14:287-291. [PMID: 27900219 PMCID: PMC5122799 DOI: 10.1016/j.aju.2016.08.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2016] [Revised: 08/07/2016] [Accepted: 08/09/2016] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE To report our multicentre experience and outcomes with laparoscopic transperitoneal and retroperitoneal upper pole heminephroureterectomy (HNU) in children with renal duplex systems and impaired upper pole. PATIENTS AND METHODS Laparoscopic HNU was performed in 22 children (15 girls, seven boys) with a mean age of 5.9 years. A retroperitoneal approach was used in 17 patients and a transperitoneal approach in the remaining five, between 2005 and 2010. Urinary tract infection was the initial presenting symptom in all children except for one with urinary retention caused by a large ureterocele. Voiding cystourethrography and renal scintigraphy revealed dual collecting systems on the right side in 11 and on the left in 11 cases. The upper pole collecting system was non-functioning in all cases. Postoperative ultrasonography was done at 1 and 3 months, with renal scintigraphy at 3 months, to check the remaining function of the lower moiety. RESULTS Overall, the mean operation time was 152 min (144 min for retroperitoneal and 160 min for transperitoneal). Blood loss was 10-50 mL and there were no intraoperative complications. The mean (SD) hospitalisation and postoperative follow-up were 3.5 (1.25) days and 22 (9.83) months, respectively. Postoperative recovery was uneventful and at the 3-month follow-up renal scintigraphy revealed no parenchymal loss of the remaining renal moiety. CONCLUSION Laparoscopic HNU in children can be performed via transperitoneal or retroperitoneal approach, both with low morbidity and with the typical benefits of laparoscopic surgery.
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Affiliation(s)
- Ali Serdar Gözen
- Department of Urology, SLK Kliniken, University of Heidelberg, Heilbronn, Germany
| | - Haytham Badawy
- Unit of Pediatric Urology, Department of Urology, University of Alexandria, Alexandria, Egypt
| | - Dogu Teber
- Department of Urology, SLK Kliniken, University of Heidelberg, Heilbronn, Germany
| | - Akram Assem
- Unit of Pediatric Urology, Department of Urology, University of Alexandria, Alexandria, Egypt
| | - Jens Rassweiler
- Department of Urology, SLK Kliniken, University of Heidelberg, Heilbronn, Germany
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Esposito C, Escolino M, Troncoso Solar B, Iacona R, Esposito R, Settimi A, Mushtaq I. Diagnosis and long-term outcome of renal cysts after laparoscopic partial nephrectomy in children. BJU Int 2016; 119:761-766. [DOI: 10.1111/bju.13698] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Ciro Esposito
- Division of Pediatric Surgery; Department of Translational Medical Sciences; Federico II University of Naples; Naples Italy
| | - Maria Escolino
- Division of Pediatric Surgery; Department of Translational Medical Sciences; Federico II University of Naples; Naples Italy
| | | | - Roberta Iacona
- Department of Paediatric Surgery; Great Ormond Street Hospital; London UK
| | - Rosanna Esposito
- Division of Pediatric Surgery; Department of Translational Medical Sciences; Federico II University of Naples; Naples Italy
| | - Alessandro Settimi
- Division of Pediatric Surgery; Department of Translational Medical Sciences; Federico II University of Naples; Naples Italy
| | - Imran Mushtaq
- Department of Paediatric Surgery; Great Ormond Street Hospital; London UK
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Antoniou D, Karetsos C. Laparoscopy or retroperitoneoscopy: which is the best approach in pediatric urology? Transl Pediatr 2016; 5:205-213. [PMID: 27867841 PMCID: PMC5107381 DOI: 10.21037/tp.2016.10.02] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
The emergence of minimally invasive surgery about 20 years ago revolutionized pediatric urology. Advances in pediatric devices allowed the widespread use of minimally invasive techniques in almost the entire range of pediatric urology. In this context, laparoscopy and later retroperitoneoscopy were developed and applied in a wide spectrum of urological diseases. Both approaches have since presented benefits and disadvantages that have been documented in various series. However, few comparative studies have been conducted. The aim of this review is to compare the two approaches and establish which is preferable in each field of pediatric urology.
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Affiliation(s)
- Dimitrios Antoniou
- Sulaiman Al Habib Hospital - Al Takhassusi, Takhassusi Road, 11393 Riyadh, KSA
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19
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Esposito C, Escolino M, Castagnetti M, Savanelli A, La Manna A, Farina A, Turrà F, Roberti A, Settimi A, Varlet F, Till H, Valla JS. Retroperitoneal and laparoscopic heminephrectomy in duplex kidney in infants and children. Transl Pediatr 2016; 5:245-250. [PMID: 27867847 PMCID: PMC5107369 DOI: 10.21037/tp.2016.09.12] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Two main techniques are adopted to perform partial nephrectomy in children: laparoscopy and retroperitoneoscopy. The aim of this paper is to review the larger multicentric experience recently published by our group to review indications, techniques and results of both approaches. METHODS Data of 102 patients underwent partial nephrectomy in a 5-year period using minimally invasive surgery (MIS) procedures were analyzed. Fifty-two children underwent laparoscopic partial nephrectomy (LPN), and 50 children underwent retroperitoneoscopic partial nephrectomy (RPN). Median age at surgery was 4.2 years. Statistical analysis was performed using χ2 test and Student's t-test. RESULTS The overall complications rate was significantly higher after RPN (15/50, 30%) than after LPN (10/52, 19%) (χ2 =0.05). In LPN group, complications [4 urinomas, 2 symptomatic refluxing distal ureteral stump (RDUS) and 4 urinary leakages] were conservatively managed. In RPN group, complications (6 urinomas, 8 RDUS, 1 opening of remaining calyxes) required a re-operation in 2 patients. In both groups no conversion to open surgery was reported. Operative time (LPN: 166.2 min vs. RPN: 255 min; P<0.001) and hospitalization (LPN: 3.5 days vs. RPN: 4.1 days; P<0.001) were significantly shorter in LPN group. No postoperative loss of renal function was reported in both groups. CONCLUSIONS MIS now represents the gold standard technique to perform partial nephrectomy in children with duplex kidney. Our results demonstrate that RPN remains a technically demanding procedure with a significantly higher complications and re-operation rate compared to LPN. In addition, length of surgery and hospitalization were significantly shorter after LPN compared to RPN. LPN seems to be a faster, safer and technically easier procedure to perform in children compared to RPN due to a larger operative space and the possibility to perform a complete ureterectomy in refluxing systems.
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Affiliation(s)
- Ciro Esposito
- Pediatric Surgery Unit, Federico II University of Naples, Naples, Italy
| | - Maria Escolino
- Pediatric Surgery Unit, Federico II University of Naples, Naples, Italy
| | | | - Antonio Savanelli
- Pediatric Surgery Unit, Federico II University of Naples, Naples, Italy
| | - Angela La Manna
- Pediatric Nephrology Unit, Second University of Naples, Naples, Italy
| | - Alessandra Farina
- Pediatric Surgery Unit, Federico II University of Naples, Naples, Italy
| | - Francesco Turrà
- Pediatric Surgery Unit, Federico II University of Naples, Naples, Italy
| | - Agnese Roberti
- Pediatric Surgery Unit, Federico II University of Naples, Naples, Italy
| | | | - Francois Varlet
- Pediatric Surgery Unit, St Etienne Hospital, St Etienne, France
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20
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Joyeux L, Lacreuse I, Schneider A, Moog R, Borgnon J, Lopez M, Varlet F, Becmeur F, Sapin E. Long-term functional renal outcomes after retroperitoneoscopic upper pole heminephrectomy for duplex kidney in children: a multicenter cohort study. Surg Endosc 2016; 31:1241-1249. [DOI: 10.1007/s00464-016-5098-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Accepted: 07/06/2016] [Indexed: 12/12/2022]
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21
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Percutaneous Cryoablation for Successful Treatment of a Persistent Urine Leak after Robotic-Assisted Partial Nephrectomy. J Vasc Interv Radiol 2015; 26:1867-70. [DOI: 10.1016/j.jvir.2015.08.029] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2015] [Revised: 08/25/2015] [Accepted: 08/28/2015] [Indexed: 11/18/2022] Open
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22
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Esposito C, Escolino M, Miyano G, Caione P, Chiarenza F, Riccipetitoni G, Yamataka A, Savanelli A, Settimi A, Varlet F, Patkowski D, Cerulo M, Castagnetti M, Till H, Marotta R, La Manna A, Valla JS. A comparison between laparoscopic and retroperitoneoscopic approach for partial nephrectomy in children with duplex kidney: a multicentric survey. World J Urol 2015; 34:939-48. [PMID: 26577623 DOI: 10.1007/s00345-015-1728-8] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2015] [Accepted: 11/03/2015] [Indexed: 02/07/2023] Open
Abstract
PURPOSE To compare the outcome of laparoscopic and retroperitoneoscopic approach for partial nephrectomy in infants and children with duplex kidneys. METHODS Data of 102 patients underwent partial nephrectomy in a 5-year period using MIS procedures were analyzed. Fifty-two children underwent laparoscopic partial nephrectomy (LPN), and 50 children underwent retroperitoneoscopic partial nephrectomy (RPN). Median age at surgery was 4.2 years. Statistical analysis was performed using χ (2) test and Student's t test. RESULTS The overall complications rate was significantly higher after RPN (15/50, 30 %) than after LPN (10/52, 19 %) [χ (2) = 0.05]. In LPN group, complications [4 urinomas, 2 symptomatic refluxing distal ureteral stumps (RDUS) and 4 urinary leakages] were conservatively managed. In RPN group, complications (6 urinomas, 8 RDUS, 1 opening of remaining calyxes) required a re-operation in 2 patients. In both groups no conversion to open surgery was reported. Operative time (LPN:166.2 min vs RPN: 255 min; p < 0.001) and hospitalization (LPN: 3.5 days vs RPN: 4.1 days; p < 0.001) were significantly shorter in LPN group. No postoperative loss of renal function was reported in both groups. CONCLUSIONS Our results demonstrate that RPN remains a technically demanding procedure with a significantly higher complications and re-operation rate compared to LPN. In addition, length of surgery and hospitalization were significantly shorter after LPN compared to RPN. LPN seems to be a faster, safer and technically easier procedure to perform in children compared to RPN due to a larger operative space and the possibility to perform a complete ureterectomy in refluxing systems.
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Affiliation(s)
- Ciro Esposito
- Department of Translational Medical Sciences, "Federico II" University of Naples, Via Pansini 5, 80131, Naples, Italy.
| | - Maria Escolino
- Department of Translational Medical Sciences, "Federico II" University of Naples, Via Pansini 5, 80131, Naples, Italy
| | - Go Miyano
- Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Paolo Caione
- Department of Pediatric Urology, Bambino Gesù Hospital, Rome, Italy
| | - Fabio Chiarenza
- Department of Pediatric Surgery, San Bortolo Hospital, Vicenza, Italy
| | | | - Atsuyuki Yamataka
- Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Antonio Savanelli
- Department of Translational Medical Sciences, "Federico II" University of Naples, Via Pansini 5, 80131, Naples, Italy
| | - Alessandro Settimi
- Department of Translational Medical Sciences, "Federico II" University of Naples, Via Pansini 5, 80131, Naples, Italy
| | - Francois Varlet
- Department of Pediatric Surgery, Centre Hospitalier Universitaire, Hopital Nord, Saint-Étienne, France
| | - Dariusz Patkowski
- Department of Pediatric Surgery, Wroclaw University, Wroclaw, Poland
| | - Mariapina Cerulo
- Department of Translational Medical Sciences, "Federico II" University of Naples, Via Pansini 5, 80131, Naples, Italy
| | | | - Holger Till
- Department of Pediatric Surgery, Medical University of Graz, Graz, Austria
| | - Rosaria Marotta
- Department of Pediatrics, Second University of Naples, Naples, Italy
| | - Angela La Manna
- Department of Pediatrics, Second University of Naples, Naples, Italy
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23
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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.
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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
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24
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Al-Hazmi HH, Farraj HM. Laparoscopic retroperitoneoscopic nephrectomy and partial nephrectomy in children. Urol Ann 2015; 7:149-53. [PMID: 25837722 PMCID: PMC4374250 DOI: 10.4103/0974-7796.150493] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2014] [Accepted: 09/22/2014] [Indexed: 11/11/2022] Open
Abstract
Objectives: The aim was to evaluate our experience in the retroperitoneal laparoscopic approach in total and partial nephrectomies in children. Materials and Methods: We retrospectively reviewed the medical records of 41 patients who underwent retroperitoneal laparoscopic total or partial nephrectomies performed in our center from 2004 to 2012. We looked at the demographic data, age at surgery, indication, operative time, surgical complications, conversion to open surgery and operative complications. Results: Thirty-five total and six partial nephrectomies (upper pole) were performed. The mean age was 84 months (7-175). Vesicoureteric reflux, pelviureteric junction obstruction, and multicystic dysplastic kidney disease were the main underlying pathologies. The mean operative time was 158 min (60-280). There were no intraoperative complications (surgical and anesthetic), and no significant blood loss was observed. Conversion to open surgery was necessary in two cases caused by failure to progress due to difficult anatomy during the partial nephrectomies. No major postoperative complications were noted. The mean hospital stay was 2.5 days (1-5). A drain was used in 12 cases and was removed after a mean of 2 days. Conclusions: Laparoscopic retroperitoneoscopic renal surgery can be carried out safely and effectively in children. Still, this procedure is more challenging and requires an excellent image of the retroperitoneal space, especially when partial nephrectomies are concerned.
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Affiliation(s)
- Hamdan H Al-Hazmi
- Department of Surgery, Division of Urology, College of Medicine and King Khalid University Hospital, King Saud University, Saudi Arabia
| | - Hamzeh M Farraj
- Department of Surgery, Division of Urology, College of Medicine and King Khalid University Hospital, King Saud University, Saudi Arabia
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25
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Bansal D, Cost NG, Bean CM, Noh PH. Pediatric laparo-endoscopic single site partial nephrectomy: feasibility in infants and small children for upper urinary tract duplication anomalies. J Pediatr Urol 2014; 10:859-63. [PMID: 24598458 DOI: 10.1016/j.jpurol.2014.01.025] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2013] [Accepted: 01/24/2014] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To assess the feasibility and outcomes of laparo-endoscopic single site (LESS) partial nephrectomy (PN) in infants and small children for upper urinary tract duplication anomalies. MATERIALS AND METHODS The medical records of all patients undergoing LESS PN at a single pediatric institution were retrospectively reviewed for patient demographics, perioperative details, and outcomes. A cystoscopy was initially performed to place an externalized catheter into the ureter of the ipsilateral normal renal moiety. An Olympus TriPort, an Olympus Endoeye flexible tip laparoscope, standard 3- or 5-mm instrumentation, and a LigaSure Blunt were utilized. RESULTS Four children (two boys, two girls) underwent LESS PN. Three patients underwent upper pole PN and one underwent lower pole PN. All procedures were performed for poorly functioning obstructed renal moieties (one ureterocele, one ureteropelvic junction obstruction and vesicoureteral reflux, and two ectopic ureters). Median age was 6.2 months (range 2.5-16.4 months). Median weight was 7.7 kg (range 6.1-12.6 kg). Median operative time was 126 min (range 97-180 min). No patient received inpatient postoperative narcotics. Median follow-up was 9.9 months (range 6.2-19.1 months). No postoperative complications were noted. Postoperative renal ultrasound demonstrated successful resection in all patients. CONCLUSIONS LESS PN is technically feasible, safe, and effective for upper urinary tract duplication anomalies in infants and small children.
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Affiliation(s)
- D Bansal
- Division of Pediatric Urology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, ML 5037, Cincinnati, OH, USA
| | - N G Cost
- Division of Pediatric Urology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, ML 5037, Cincinnati, OH, USA
| | - C M Bean
- Division of Pediatric Urology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, ML 5037, Cincinnati, OH, USA
| | - P H Noh
- Division of Pediatric Urology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, ML 5037, Cincinnati, OH, USA.
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26
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Cohen J, Mullins JK, Jayram G, Patel HD, Pierorazio PM, Matlaga BR, Allaf ME. Trends and outcomes of total and partial nephrectomy in children: a statewide analysis. J Pediatr Urol 2014; 10:717-23. [PMID: 24556170 DOI: 10.1016/j.jpurol.2013.12.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2013] [Accepted: 12/10/2013] [Indexed: 01/24/2023]
Abstract
OBJECTIVE To report trends in surgical approach and associations with outcomes in children undergoing extirpative renal surgery in the state of Maryland over a 12-year period. METHODS The Maryland Health Services Cost Review Commission (HSCRC) database was queried to identify children undergoing total or partial nephrectomy between 2000 and 2011. Demographic, clinical, hospital, and charge data were compared between children undergoing open and minimally invasive renal surgery. Multivariable logistic regression analysis was performed to identify independent predictors of prolonged length of hospital stay and 30-day readmission. Multivariable linear regression was performed to identify independent predictors of increased hospital charges. RESULTS Of the 346 children undergoing extirpative renal surgery, 289 (83.5%) underwent total nephrectomy and 48 (13.9%) underwent minimally invasive surgery. Utilization of minimally invasive surgery for congenital urinary anomalies has steadily increased from 15% to 35% over the past decade. Children undergoing minimally invasive total nephrectomy were healthier, had shorter hospital stay, and were more likely to have surgery at a high-volume institution. No such differences were noted in patients undergoing open and minimally invasive partial nephrectomy. On multivariable regression analyses, high patient complexity was the main predictor of increased length of stay (OR 16.02, 95% CI 7.06-36.31), 30-day readmission (OR 3.04, 95% CI 1.38-6.70), and total hospital charge (p < 0.001). CONCLUSION In Maryland hospitals, most extirpative renal surgeries in children are total nephrectomies performed using an open technique by high-volume surgeons. Although the overall proportion of minimally invasive surgeries has not increased over time, the utilization of MIS in congenital anomaly cases has. Patient complexity and not operative approach dictates postoperative morbidity and hospital charges.
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Affiliation(s)
- Jason Cohen
- James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Jeffrey K Mullins
- James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Gautam Jayram
- James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, MD, USA.
| | - Hiten D Patel
- James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Phillip M Pierorazio
- James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Brian R Matlaga
- James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Mohamad E Allaf
- James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, MD, USA
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27
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Robotic-assisted partial nephrectomy in duplicated collecting systems in the pediatric population: techniques and outcomes. J Pediatr Urol 2014; 10:374-9. [PMID: 24268881 DOI: 10.1016/j.jpurol.2013.10.014] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2013] [Accepted: 10/16/2013] [Indexed: 11/23/2022]
Abstract
OBJECTIVE We present our experience with pediatric robotic-assisted laparoscopic partial nephrectomy of a nonfunctioning moiety in a duplicated system (RALPN), comparing techniques and outcomes with those previously reported in the literature. To our knowledge, this is the largest series of this surgical procedure to date. PATIENTS AND METHODS We retrospectively reviewed all pediatric patients at our institution that had undergone RALPN from 2006 to 2012. RESULTS Twenty-one patients underwent RALPN between 2006 and 2012. Mean patient age was 4.1 years. Mean operative time was 301 min. Mean estimated blood loss was 36 ml. Mean length of stay was 38 h. The majority of cases were performed with three laparoscopic ports. At initial follow-up ultrasound 6/21 (29%) demonstrated a fluid collection. The majority of these collections occurred in cases where the resection defect was not closed intraoperatively (42% of cases vs. 11% of cases). All fluid collections were asymptomatic and managed conservatively. CONCLUSION RALPN is associated with low complication rates. The robotic system allows for the use of only two small robotic working ports in most cases. Postoperative fluid collections may be prevented by formal closure of the polar defect, but fluid collections that do occur can be followed conservatively.
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28
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Cabezali D, Maruszewski P, López F, Aransay A, Gomez A. Complications and late outcome in transperitoneal laparoscopic heminephrectomy for duplex kidney in children. J Endourol 2013; 27:133-8. [PMID: 23005915 DOI: 10.1089/end.2012.0379] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
PURPOSE We report our experience with laparoscopic heminephrectomy (LH) in children with duplex kidneys, emphasizing complications and late outcomes, and including anatomic and functional aspects. PATIENTS AND METHODS We retrospectively reviewed medical data of 28 children with a duplex kidney who underwent LH. Complications were evaluated according to the Savata and Clavien classiffication systems. RESULTS Nineteen upper (67.8%) and 9 (32.1%) lower moieties were removed. All laparoscopic procedures were completed as planned without conversion. There were three (10.5%) cases of intraoperative bleeding successfully controlled by compression with gauze. Complications after surgery included two urinomas (7%), one intra-abdominal hematoma (3.5%), and two cases of complete functional loss (7%) because of torsion of the remnant upper pole. In six (21.4%) cases, a cyst at the resection margin of the kidney remnant was found. The function of the remnant pole was preserved in 23 (82.1%) cases and decreased in approximately 5% in 3 (10.5%). CONCLUSIONS The anatomic and functional outcomes of LH must be evaluated with imaging studies and nuclear scintigraphy to rule out structural abnormalities and functional impairment. An extensive dissection in the lower pole LH can lead to the upper moiety torsion after surgery.
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Affiliation(s)
- Daniel Cabezali
- Department of Pediatric Urology, Hospital 12 Octubre, Madrid, Spain.
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Barbosa JABA, Barayan G, Gridley CM, Sanchez DCJ, Passerotti CC, Houck CS, Nguyen HT. Parent and patient perceptions of robotic vs open urological surgery scars in children. J Urol 2012; 190:244-50. [PMID: 23276511 DOI: 10.1016/j.juro.2012.12.060] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2012] [Accepted: 12/19/2012] [Indexed: 12/19/2022]
Abstract
PURPOSE Cumulative evidence shows that robot-assisted laparoscopic surgery is safe and at least as efficacious as open surgery for several pediatric urological procedures. Scars resulting from robotic surgery are often assumed to have a cosmetic advantage. However, no study has clearly demonstrated that parents and patients consistently prefer such scars. MATERIALS AND METHODS We developed 3 distinct surveys consisting of photographs and diagrams of scars resulting from open and robot-assisted laparoscopic surgery for ureteral reimplantation, pyeloplasty and bladder augmentation. Surveys were distributed to parents of patients being evaluated for 1 of the 3 procedures. The surveys evaluated information such as scar preference, reason for preference and demographics. Patients older than 7 years also completed surveys. RESULTS Robot-assisted laparoscopic surgical scars were preferred by parents for all procedures studied (85% for ureteral reimplant, 63% for pyeloplasty and 93% for bladder augmentation). Patients also preferred the robotic scars (76%, 62% and 91%, respectively). Patients and parents did not differ significantly in scar preference or in rating of factors affecting decision. Scar size was important or very important to 80% of parents for reimplant, 83% for pyeloplasty and 86% for bladder augmentation. However, the majority of parents would ultimately base their choice of surgical approach on clinical efficacy rather than scar preference. CONCLUSIONS Parents and patients prefer robot-assisted laparoscopic surgical scars to open surgical scars for pediatric ureteral reimplantation, pyeloplasty and bladder augmentation. Scar appearance is an important influence on the decisions of parents and patients, and should be discussed when surgical treatment is presented.
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Affiliation(s)
- Joao A B A Barbosa
- Robotic Surgery, Research and Training Center, and Department of Urology, Boston Children's Hospital, Boston, Massachusetts 02115, USA
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Pediatric open partial nephrectomy: analysis of contemporary outcomes with a supracostal-12 approach. J Pediatr Urol 2012; 8:509-13. [PMID: 22027568 DOI: 10.1016/j.jpurol.2011.10.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2011] [Accepted: 10/06/2011] [Indexed: 11/20/2022]
Abstract
OBJECTIVE Reports in the literature increasingly have demonstrated a shorter length of stay (LOS) with the laparoscopic approach to partial nephrectomy compared to historic open partial nephrectomy. We present data from the largest open series to date, to provide a more contemporary perspective. METHODS A retrospective review was performed on all pediatric patients who underwent upper pole partial nephrectomy from 1999 to 2011. Using univariate and multivariate linear regression, the associations between multiple explanatory covariates and outcomes such as pain and length of stay were analyzed. RESULTS Twenty-five surgeries were performed via a supracostal-12 approach. The mean incision length and operative time was 3.7 cm and 137 min, respectively. The average pain score was 1.7/10 and 72% of patients did not require morphine. The mean LOS was 36 h and all patients with postoperative imaging had normal blood flow. Multivariate analysis demonstrated that a later date of surgery was the only covariate significantly associated with decreased operative time and LOS. CONCLUSION Open partial nephrectomy can be performed in a minimally invasive manner via a small supracostal-12 incision with minimal pain and LOS. Surgeon experience is associated with decreased operative time and LOS. These contemporary open results should be considered when comparisons are made with laparoscopic surgery.
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Mason MD, Peters CA, Schenkman NS. Robot-Assisted Upper Pole Nephrectomy in Adult Patients with Duplicated Renal Collecting Systems. J Endourol 2012; 26:838-42. [DOI: 10.1089/end.2011.0377] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Affiliation(s)
- Matthew D. Mason
- Department of Urology, University of Virginia Health System, Charlottesville, Virginia
| | - Craig A. Peters
- Department of Urology, University of Virginia Health System, Charlottesville, Virginia
- Sheikh Zayed Institute for Pediatric Surgical Innovation, Children's National Medical Center, Washington, District of Columbia
- Department of Urology, Children's Hospital, Boston, Massachusetts
| | - Noah S. Schenkman
- Department of Urology, University of Virginia Health System, Charlottesville, Virginia
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Abstract
UNLABELLED What's known on the subject? and What does the study add? Robot assisted laparoscopic surgery (RALS) is slowly gaining acceptance in the field of paediatric urology. Accumulating data on safety and efficacy when performing paediatric robotic urologic procedures has led paediatric urologists to gradually embrace increasingly more complex reconstructive surgeries. Indeed, the unique and delicate movements generated by the robotic system make this technology ideal for children who often require reconstructive procedures. We critically review the current role of RALS in paediatric urology and to analyse the published data, with a special emphasis on the most common applications. We also propose a structured plan to expedite training and the surgical 'learning curve'. OBJECTIVES To critically review the current role of robot-assisted laparoscopic surgery (RALS) in paediatric urology and to analyse the published data, with a special emphasis on the most common applications. One of the greatest benefits of RALS has been the ability to truly spread the application of minimally invasive surgery to paediatric surgical patients. The unique attributes of the robotic interface make this technology ideal for children with congenital anomalies, who often require reconstructive procedures. We also propose a structured plan to expedite training and the surgical 'learning curve'. PATIENTS AND METHODS Currently, almost all urological surgical procedures in children have been performed with the assistance of the robotic interface. The most commonly performed procedures include pyeloplasty, nephrectomy/hemi-nephrectomy and surgery for vesico-ureteric reflux. Initial series of bladder augmentation and appendicovesicostomy are available. RESULTS Initial results with RALS are encouraging and have shown safety similar to open procedures, and outcomes at least equivalent to standard laparoscopy. Accumulating data have consistently shown that postoperative analgesia requirements and overall hospital stay are decreased. However, operative durations are significantly longer than their open counterparts, but this is decreasing as experience accumulates. CONCLUSIONS RALS is already part of paediatric urological surgery. Larger single-institution case series and comparative studies with the open approach and multi-institutional meta-analyses will help to identify the benefits of RALS in paediatric urology.
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Affiliation(s)
- Marcelo A Orvieto
- Pediatric Urology, Section of Urology –Department of Surgery, University of Chicago, Comer Children's Hospital and Pritzker Medical School, Chicago, IL, USA
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Hidas G, Watts B, Khoury AE. The evolving role of laparoscopic surgery in paediatric urology. Arab J Urol 2012; 10:74-80. [PMID: 26558007 PMCID: PMC4442882 DOI: 10.1016/j.aju.2011.12.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2011] [Revised: 12/01/2011] [Accepted: 12/03/2011] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES We review the various applications of laparoscopic and robotic-assisted laparoscopy in paediatric urology, as the laparoscopic and robotic approach in this population is gradually being recognised. METHODS We searched PubMed for human studies in English that were published between 1990 and the present, focusing on laparoscopic nephrectomies and partial nephrectomies, laparoscopic and robotic pyeloplasties and ureteric reimplantation, laparoscopic orchidopexy and varicocelectomy. We also reviewed robotic-assisted laparoscopic urological major reconstructions. Key articles were reviewed, extracting the indications, techniques, and the advantages and disadvantages. RESULTS AND CONCLUSIONS Laparoscopy has a defined place in modern paediatric urological surgery. Laparoscopic nephrectomies, pyeloplasties and abdominal exploration for the evaluation and management of impalpable undescended testicles have become the standard of care. Robotic-assisted laparoscopic surgery is developing as a safe and effective option even for infant patients.
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Affiliation(s)
- Guy Hidas
- Department of Paediatric Urology, UC Irvine and Children's Hospital of Orange County, Orange, CA, USA
| | - Blake Watts
- Department of Paediatric Urology, UC Irvine and Children's Hospital of Orange County, Orange, CA, USA
| | - Antoine E Khoury
- Department of Paediatric Urology, UC Irvine and Children's Hospital of Orange County, Orange, CA, USA
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Abedinzadeh M, Nouralizadeh A, Radfar MH, Moslemi MK. Transperitoneal laparoscopic heminephrectomy in duplex kidneys: a one centre experience. GERMAN MEDICAL SCIENCE : GMS E-JOURNAL 2012; 10:Doc05. [PMID: 22355281 PMCID: PMC3278976 DOI: 10.3205/000156] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/30/2011] [Revised: 01/22/2012] [Indexed: 11/30/2022]
Abstract
PURPOSE The standard treatment for a duplex kidney with poorly functioning upper pole moiety is ipsilateral upper pole heminephrectomy. This procedure is usually performed by open surgery, but with recent developments in techniques of uro-laparoscopy, it can be done with it, safely. In this study we evaluated the results and safety of laparoscopic heminephrectomy in our consecutive cases. MATERIALS AND METHODS From February 2001 to May 2007 fourteen unilateral laparoscopic heminephrectomy were performed in our center. Patients' characteristics, presenting symptoms, operative time, and blood loss, early and late complications were all collected retrospectively. Using pre-operative ultrasonography, intravenous pyelography (IVP) and CT scanning, unilateral upper pole hydronephrosis was detected in all cases. By DMSA isotope scan hypofunctioning of ipsilateral moieties was detected in all cases. RESULTS Mean operative time was 203±80 minutes. No major intra-operative or early complications were identified. Mean hospital stay was 4.1 days. On mean follow-up of 32 months no disturbing symptoms or episodes of urinary tract infections (UTIs) were detected. Atrophic kidney was detected in one case in post-operative IVP. CONCLUSION Laparoscopic heminephrectomy is a valuable minimal invasive procedure that can be performed safely in experienced hands without any important complication. Perfect renal pedicles vascular system manipulation is important for the preservation of renal function post-operatively.
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Affiliation(s)
- Mehdi Abedinzadeh
- Department of Urology, Moradi Hospital, School of Medicine, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
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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
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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]
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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.
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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.
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Cascio S, Winning J, Flett ME, Fyfe AH, O'Toole S. Open versus prone retroperitoneoscopic partial nephrectomy in children: a comparative study. J Pediatr Urol 2011; 7:61-4. [PMID: 20207587 DOI: 10.1016/j.jpurol.2010.02.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2009] [Accepted: 02/02/2010] [Indexed: 10/19/2022]
Abstract
PURPOSE To compare the outcomes of open (OPN) and prone retroperitoneoscopic partial nephrectomy (PRPN) in children. MATERIALS AND METHODS The medical and radiological records of all children undergoing OPN and PRPN over a 6-year period (2002-2008) were reviewed. RESULTS Thirty-nine (11 boys/28 girls) partial nephrectomies were performed in a single institution. There were 24 OPNs (15 upper, 9 lower) and 15 PRPNs (13 upper, 2 lower) with a median age at surgery of 2.3 years and 3.4 years, respectively. Median duration of surgery was 50 min (range 30-180) for the OPN and 150 min (range 70-205) for the PRPN (P < 0.001). Median postoperative hospital stay was 4 days (range 2-7) for the OPN and 2 days (range 1-5) for the PRPN (P < 0.001). One patient in the OPN underwent a total nephrectomy with a loss of the remaining moiety. In 20 (87%) patients of the OPN group an epidural infusion was administered and four required a morphine infusion, while only five patients in the PRPN group required a morphine infusion. CONCLUSIONS Open partial nephrectomy had a significantly shorter operative time, but it was associated with a longer postoperative stay and higher analgesia requirements when compared to PRPN.
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Affiliation(s)
- Salvatore Cascio
- Department of Urology, Royal Hospital for Sick Children, Glasgow G3 8SJ, Scotland, UK.
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Koh CJ, De Filippo RE, Chang AY, Hardy BE, Berger A, Eisenberg M, Patil M, Aron M, Gill IS, Desai MM. Laparoendoscopic single-site nephrectomy in pediatric patients: initial clinical series of infants to adolescents. Urology 2010; 76:1457-61. [PMID: 20970837 DOI: 10.1016/j.urology.2010.06.066] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2010] [Revised: 06/04/2010] [Accepted: 06/04/2010] [Indexed: 02/08/2023]
Abstract
OBJECTIVES To present our initial clinical series of laparoendoscopic single-site (LESS) nephrectomy using an umbilical incision in children ranging from infants to adolescents. Laparoscopic surgery in pediatric urology is increasingly being performed for many intra-abdominal ablative procedures, such as nephrectomy for poorly functioning kidneys. We have previously reported our initial experience with LESS surgery in the adult population. METHODS A total of 11 pediatric patients (age range 0.1-16.2 years, mean 5.7) underwent LESS nephrectomy using an umbilical incision. The perioperative clinical parameters were reviewed retrospectively. RESULTS The 11 LESS pediatric nephrectomies were technically successful without conversion to conventional laparoscopy or open surgery. An accessory port was used in 5 of the cases early in the clinical series. Of the 11 patients, 2 were infants, aged 39 days and 3.5 months. The mean operative time was 139 minutes (range 85-205), and the mean hospital stay was 1.5 days (range 1.0-2.1). Complications included delayed hydrocele formation in 2 male patients. CONCLUSIONS The results of our study have shown that LESS nephrectomy using a single umbilical incision in pediatric patients is technically feasible with good outcomes. Additional studies are needed to evaluate the expected benefits of this novel technique. Also, miniaturization of currently available equipment is needed to adapt to the small working spaces available in the pediatric patient.
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Affiliation(s)
- Chester J Koh
- Division of Pediatric Urology, Children's Hospital Los Angeles, Los Angeles, California 90027, USA.
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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.
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Gao Z, Wu J, Lin C, Men C. Transperitoneal laparoscopic heminephrectomy in duplex kidney: our initial experience. Urology 2010; 77:231-6. [PMID: 20381844 DOI: 10.1016/j.urology.2010.02.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2009] [Revised: 01/28/2010] [Accepted: 02/01/2010] [Indexed: 10/19/2022]
Abstract
OBJECTIVES To study the feasibility, safety, and effect of transperitoneal laparoscopic heminephrectomy in the duplex kidney. METHODS From December 2003 to January 2008, 18 patients with urinary tract duplex anomalies underwent laparoscopic heminephrectomy using a transperitoneal approach. The sites of surgery consisted of 6 right upper, 2 right lower, 9 left upper, and 1 left lower heminephrectomy. Follow-up studies were performed using renal ultrasonography in all patients. RESULTS All patients underwent laparoscopic surgery successfully without conversion to open surgery or intraoperative complications. The mean operative time was 142.8 minutes (range 90-195). The mean estimated blood loss was 196.1 mL (range 20-600), and the mean hospital stay was 6.1 days (range 4-10). In 1 patient, a minor postoperative urine leak resolved spontaneously with prolonged catheter drainage. The radiologic assessment showed normal ipsilateral renal growth in 18 patients at a mean follow-up of 25.8 months. CONCLUSIONS Our initial clinical experience suggests that laparoscopic heminephrectomy using a transperitoneal approach for the duplex kidney is feasible, safe, and effective. Therefore, the transperitoneal approach for moiety excision, which offers a technically simple approach for complete ureterectomy, is recommended.
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Affiliation(s)
- Zhenli Gao
- Department of Urology, Yantai Yuhuangding Hospital, Yantai, Shandong Province, China.
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Laparoscopic transperitoneal partial nephrectomy in children under 2 years old: a single-centre experience. J Pediatr Urol 2010; 6:166-70. [PMID: 19647490 DOI: 10.1016/j.jpurol.2009.06.012] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2009] [Accepted: 06/22/2009] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To report our experience with laparoscopic transperitoneal (TP) heminephrectomy for duplicated pyeloureteral systems in children under 2 years old. PATIENTS AND METHODS We retrospectively reviewed the intraoperative evolution and patient outcome of 10 laparoscopic partial ureteronephrectomies (7 upper and 3 lower pole nephrectomies) using a TP approach, performed over 4 years. Mean age at surgery was 9.1 months (range 3.5-20.4), with seven children younger than 1 year. Average follow up based on clinical examinations and renal ultrasounds was 13.9 months (range 1.2-38.5). RESULTS The average operative time was 123 min (range 90-195). There was no need for conversion and no intraoperative complications. Mean postoperative hospital stay was 2.9 days. A perirenal collection with spontaneous regression occurred in one case. The main postoperative complication consisted of a diminution in renal function with pyelic dilation in a 4-month-old child, due to inadequate positioning of the remaining moiety. This child remains asymptomatic 3 years after surgery. CONCLUSIONS We recommend a TP approach for laparoscopic heminephrectomy due to the improved vascular exposure and control, diminished need for renal mobilization, and greater working space that can be obtained, especially in toddlers with a higher morbidity rate caused by the lack of retroperitoneal space.
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Heminephroureterectomy for duplex kidney: laparoscopy versus open surgery. J Pediatr Urol 2010; 6:157-60. [PMID: 19679515 DOI: 10.1016/j.jpurol.2009.07.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2009] [Accepted: 07/20/2009] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To report our experience of laparoscopic heminephroureterectomy (Hnu) in pediatric patients with duplex anomalies, in comparison to open surgery. PATIENTS AND METHODS Retrospective review of data from patients who underwent Hnu from 2005 to 2008 was performed. The patients were divided into two groups: laparoscopic (LHnu) and open surgery (OHnu). Laparoscopic surgery was performed by transperitoneal approach in majority of cases. Open surgery was performed by retroperitoneal approach in all cases. RESULTS Group LHnu: nine patients (8 females, 1 male) with median age of 14 months (range 3-205). Transperitoneal approach was performed in eight patients. Mean operative time was 182 min (CI 95% 146-217). No conversion to open surgery was necessary and there were no complications. Mean hospital stay was 2.44 days (CI 95% 1.37-3.52). Group OHnu: eight patients (3 females, 5 males) underwent nine heminephrectomies at median age of 6.9 months (range 1-12). Mean operating time was 152 min (CI 95% 121-183). There were no complications and mean hospital stay was 4.38 (CI 95% 2.59-6.16) days. Statistical analysis showed no statistically significant difference (P>0.05) in operating time between groups while mean hospital stay was significant (P=0.021). CONCLUSION The laparoscopic approach is feasible, safe, reduces hospital stay, does not increase operating time and has better cosmetic results. We believe this should be the first option for heminephrectomy.
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Zumsteg J, Roberts WW, Wolf JS. Laparoscopic heminephrectomy for benign renal anomalies. J Endourol 2010; 24:41-7. [PMID: 19958148 DOI: 10.1089/end.2009.0346] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND AND PURPOSE Benign renal conditions, such as duplication and fusion anomalies, are relatively common and may lead to problems such as chronic flank pain or urinary tract infection. Traditional management of these conditions has been open surgical removal of the affected moiety. As an alternative, we report on our experience with laparoscopic heminephrectomy for benign renal anomalies and emphasize the technical aspects of the procedures. PATIENTS AND METHODS We retrospectively reviewed the records of patients who underwent laparoscopic heminephrectomy for benign renal anomalies at our institution between February 1999 and April 2009. RESULTS Heminephrectomy was performed in 11 patients, including 8 with duplicated collecting systems, 2 with horseshoe kidneys, and 1 with a cross-fused renal ectopic kidney. Median operative time was 204 minutes, and median estimated blood loss was 250 mL. There were no intraoperative complications. The presenting symptoms resolved in all patients. There were three major and two minor postoperative complications, including 50% loss of remaining ipsilateral renal parenchyma, postoperative neuralgia and anejaculation, urinoma, and partial wound separation. Median length of hospital stay was 2 days. Renal function was well preserved in all patients. The median change in serum creatinine level was 0.1 mg/dL. CONCLUSIONS Although laparoscopic heminephrectomy is challenging because of the variable blood supply and abnormal anatomy of the kidney, with careful planning and attention to detail, the procedure is safe and effective for the management of a wide range of benign renal anomalies that necessitate heminephrectomy and offers the usual recovery advantages of laparoscopy.
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Affiliation(s)
- Justin Zumsteg
- Department of Urology, University of Michigan Health System, Ann Arbor, Michigan 48109-5330, USA
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Lee RS, Sethi AS, Passerotti CC, Peters CA. Robot-assisted laparoscopic nephrectomy and contralateral ureteral reimplantation in children. J Endourol 2010; 24:123-8. [PMID: 19958154 DOI: 10.1089/end.2009.0271] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Robot-assisted laparoscopic surgery (RALS) has expanded the role for minimally invasive surgery within pediatrics. RALS may be particularly beneficial for the treatment of children with a refluxing nonfunctioning renal moiety and contralateral vesicoureteral reflux. In this report, we describe a single RALS procedure, which includes both nephrectomy or partial nephrectomy, and contralateral extravesical ureteral reimplantation (EVUR). METHODS A retrospective review was performed of four patients who underwent RALS nephrectomy/partial nephrectomy and concurrent EVUR in one setting. Procedures were performed by a single surgeon using a robot-assisted laparoscopic approach. Four ports were used in a transperitoneal approach with patient positioning changed without moving the robotic system between the nephrectomy and reimplant. We described the technique and assessed its safety and efficacy. RESULTS All cases were treated with the single RALS approach. Mean patient age was 2.3 years. Three patients underwent a nephrectomy and one a lower pole partial nephrectomy. The mean estimated blood loss was 16 mL, mean operative time was 291 minutes, and mean length of stay was 2.3 days. There was one case of postoperative ureteral obstruction that was treated with 3 weeks of ureteral stenting without further sequela. Overall, the mean follow-up time was 21 months and follow-up renal ultrasonographs and radionuclide cystograms were normal in all patients. CONCLUSIONS A single RALS procedure that combines nephrectomy/partial nephrectomy and EVUR offers a novel approach to a clinical dilemma that often requires two operations. In this small series, RALS was safe and efficacious. We recommend routine Double-J stenting for the solitary reimplanted ureter.
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Affiliation(s)
- Richard S Lee
- Department of Urology, Children's Hospital Boston, Boston, Massachusetts, USA
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Lee DJ, Kim PH, Koh CJ. Current trends in pediatric minimally invasive urologic surgery. Korean J Urol 2010; 51:80-7. [PMID: 20414418 PMCID: PMC2855486 DOI: 10.4111/kju.2010.51.2.80] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2010] [Accepted: 02/12/2010] [Indexed: 12/12/2022] Open
Abstract
Over the past two decades, laparoscopic and robotic surgery in children has been described as a viable minimally invasive alternative to open surgery for many pediatric urologic conditions. With the goal of reducing the morbidity associated with open surgery, minimally invasive surgery in children is increasingly being performed as laparoscopic and robotic patients appear to be experiencing shorter hospital stays, decreased pain medication requirements, and the potential for improved cosmesis. This article provides an overview of the existing literature in laparoscopic and robotic-assisted laparoscopic urologic surgery in children. Laparoscopic and robotic-assisted laparoscopic surgery appears to be safe and effective in children for a wide range of ablative and reconstructive procedures. Conventional laparoscopic surgery is effective for ablative procedures, while robotic surgery may be ideally suited for reconstructive cases requiring advanced suturing and dissection. Overall, more prospective studies are needed to study the long-term outcomes of minimally invasive surgery in pediatric patients, and the appropriate use of the available technology.
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Affiliation(s)
- Dennis J Lee
- Department of Pediatric Urology, Childrens Hospital Los Angeles, University of Southern California (USC) Institute of Urology, Keck School of Medicine, USC, Los Angeles, California, USA
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Abstract
The use of laparoscopy has evolved over the last 30 years, particularly in the last decade, from merely extirpative or diagnostic procedures to intricate reconstructive procedures on the major genitourinary organs. The development of laparoscopy as a method of treating urological problems has progressed more slowly in children compared with adults; perhaps due to the availability of miniaturized technology, the steep learning curve and the high success of traditional open surgery. This article seeks to provide a comprehensive review of the evolution of laparoscopy from its inception to its present-day applications in the field of pediatric urology, including the current indications and results of various laparoscopic procedures.
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Affiliation(s)
- Regina D Norris
- Children's Hospital of Pittsburgh, Pediatric Urology, 45th and Penn Avenue, 4th Floor Faculty Pavilion, Pittsburgh, PA 15201, USA
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You D, Bang JK, Shim M, Ryu DS, Kim KS. Analysis of the late outcome of laparoscopic heminephrectomy in children with duplex kidneys. BJU Int 2009; 106:250-4. [PMID: 19888983 DOI: 10.1111/j.1464-410x.2009.09038.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
OBJECTIVES To report our experience with laparoscopic heminephrectomy (LHN) in children with duplex kidneys, highlighting the late outcomes, including anatomical and functional aspects. PATIENTS AND METHODS We retrospectively analysed the medical records of 17 children (18 renal units) with duplex kidneys who underwent LHN (15) and heminephroureterectomy (three). Before surgery, all patients were evaluated using ultrasonography, voiding cysto-urethrography, computed tomography or magnetic resonance imaging with urography, and nuclear scintigraphy. After surgery patients were evaluated using ultrasonography and nuclear scintigraphy, and by voiding cysto-urethrography if there was a refluxing ureter. RESULTS All laparoscopic surgery (17 transperitoneal and one retroperitoneal approach), were completed as planned with no intraoperative complications. Complications after surgery included prolonged urine leakage from a refluxing ureteric stump in one heminephroureterectomy, and a complete functional loss of the remnant pole in one retroperitoneal LHN. The function of the remnant pole was preserved in 17 patients (94%); in these 17 the mean decrease in renal function was 2.8%. Follow-up ultrasonography showed asymptomatic cystic structures in six patients. There was an asymptomatic remnant ureteric stump in two cases (one refluxing, one nonrefluxing). CONCLUSION The loss of function caused by surgery is subtle but some remnant pole will be fully lost while experience is gained. Because the functional impairment due to vasospasm or vascular injury might not be recognized, all remnant kidneys must be evaluated using postoperative nuclear scintigraphy.
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Affiliation(s)
- Dalsan You
- Department of Urology, University of Ulsan College of Medicine, Seoul, Korea
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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.
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