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Miyake Y, Fujiwara K, Kataoka K, Ochi T, Seo S, Koga H, Lane GJ, Nishimura K, Hayashida M, Yamataka A. Retroperitoneoscopic Surgery in Children Does Not Cause Pathological Desaturation in Cerebral/Renal Oxygenation on Near-Infrared Spectroscopy Compared with Laparoscopic and Thoracoscopic Surgery. J Laparoendosc Adv Surg Tech A 2022; 32:1260-1264. [PMID: 35904967 DOI: 10.1089/lap.2022.0241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Introduction: Cerebral and renal regional oxygen saturation (C-rSO2 and R-rSO2, respectively) were monitored using near-infrared spectroscopy in pediatric patients (range: 0.3-14.3 years) during minimally invasive surgery (MIS) taking at least 3 hours performed by laparoscopy (Lap), thoracoscopy (Tho), or retroperitoneoscopy (Ret) from January 2019 to December 2021. Materials and Methods: Criteria compared were operative time, preoperative/intraoperative hemoglobin, blood loss, mean arterial pressure, arterial partial pressure of carbon dioxide (PaCO2), peripheral oxygen saturation (SpO2), C-rSO2, and R-rSO2. Pathological desaturation (PD) was defined as >20% decrease from baseline, and statistical significance as P < .05. Results: Subjects (n = 79) were similar for gender, age, and body mass index. MIS procedures were: Lap = 45, Tho = 20, Ret = 14; one Lap case required conversion for severe adhesions, not PD. Intraoperative PaCO2 (mmHg) was significantly higher in Tho (maximum: 59.5 ± 17.0, minimum: 39.9 ± 7.5) versus Lap (maximum: 39.9 ± 5.1, minimum: 34.6 ± 3.9) and Ret (maximum: 37.8 ± 4.2, minimum: 35.0 ± 3.3); P < .0001 (maximum), P = .0013 (minimum). Minimum intraoperative SpO2 was significantly lower in Tho (P < .0001). Mean operative times were significantly shorter in Tho (259 ± 114 minutes) versus Lap (433 ± 154 minutes) and Ret (342 ± 100 minutes); P < .0001, respectively. PD was absent during Ret (C-rSO2: 0/14 = 0% and R-rSO2: 0/14 = 0%). Differences in PD for Lap (C-rSO2: 7/45 = 15.6% and R-rSO2: 10/45 = 22.2%) and Tho (C-rSO2: 9/20 = 45.0%, and R-rSO2: 7/20 = 35.0%) were significant; P = .0028 for C-rSO2 and P = .0497 for R-rSO2. Hemoglobin and blood loss were similar. Conclusions: PD was absent during Ret, despite longer operative times. If Ret is indicated for a procedure, neurodevelopmental sequelae of MIS could be minimized.
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Affiliation(s)
- Yuichiro Miyake
- Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Kentaro Fujiwara
- Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Kumi Kataoka
- Department of Anesthesiology and Pain Medicine, Juntendo University School of Medicine, Tokyo, Japan
| | - Takanori Ochi
- Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Shogo Seo
- Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Hiroyuki Koga
- Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Geoffrey J Lane
- Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Kinya Nishimura
- Department of Anesthesiology and Pain Medicine, Juntendo University School of Medicine, Tokyo, Japan
| | - Masakazu Hayashida
- Department of Anesthesiology and Pain Medicine, Juntendo University School of Medicine, Tokyo, Japan
| | - Atsuyuki Yamataka
- Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine, Tokyo, Japan
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Chiarenza SF, Bucci V, Zolpi E, La Pergola E, Bleve C, Fasoli L. Retroperitoneoscopic Nephrectomy in Pediatric Patients. J Laparoendosc Adv Surg Tech A 2021; 31:1209-1213. [PMID: 34591694 DOI: 10.1089/lap.2021.0464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Minimally invasive surgery (MIS) in pediatric population is becoming more and more popular among pediatric urologists and now it can be considered the best treatment for nephroureterectomy that is one of the most frequent urological procedures. The main indications to MIS ureteronephrectomy in children are congenital or acquired benign conditions such as nonfunctional and/or damaging kidney, renal dysplasia, and destroyed kidneys due to obstructive or refluxing uropathy. Since ever in open urological surgery, the lateral retroperitoneal approach represents the typical way to approach this kind of surgery. Although different surgical approaches can be chosen (i.e., posterior retroperitoneal, lateral retroperitoneal, laparoscopic transperitoneal, and robotic approach), the lateral retroperitoneal approach represents the typical way to perform this kind of surgery, also with minimally invasive techniques. In this article, we illustrate the technique of retroperitoneoscopic nephroureterectomy in infants and children, reporting our experience with this technique in the past 20 years.
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Affiliation(s)
- Salvatore Fabio Chiarenza
- Pediatric Surgery and Urologic Unit, Regional Center of Minimally Invasive Surgery and Urology, San Bortolo Hospital, Vicenza, Italy
| | - Valeria Bucci
- Pediatric Surgery and Urologic Unit, Regional Center of Minimally Invasive Surgery and Urology, San Bortolo Hospital, Vicenza, Italy
| | - Elisa Zolpi
- Pediatric Surgery and Urologic Unit, Regional Center of Minimally Invasive Surgery and Urology, San Bortolo Hospital, Vicenza, Italy
| | - Enrico La Pergola
- Pediatric Surgery and Urologic Unit, Regional Center of Minimally Invasive Surgery and Urology, San Bortolo Hospital, Vicenza, Italy
| | - Cosimo Bleve
- Pediatric Surgery and Urologic Unit, Regional Center of Minimally Invasive Surgery and Urology, San Bortolo Hospital, Vicenza, Italy
| | - Lorella Fasoli
- Pediatric Surgery and Urologic Unit, Regional Center of Minimally Invasive Surgery and Urology, San Bortolo Hospital, Vicenza, 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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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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Szavay PO. Applications of Laparoscopic Transperitoneal Surgery of the Pediatric Urinary Tract. Front Pediatr 2019; 7:29. [PMID: 30805327 PMCID: PMC6378287 DOI: 10.3389/fped.2019.00029] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Accepted: 01/23/2019] [Indexed: 12/23/2022] Open
Abstract
Application of laparoscopy in pediatric urology has evolved over more than 30 years coming from a merely diagnostic use for non-palpable testes to "interventional" laparoscopy to extirpative surgery and finally to the era of reconstructive pediatric laparoscopic urology, when in 1995 Peters described the first laparoscopic pyeloplasty in a child. Laparoscopic surgery in pediatric urology became implemented increasingly in the twenty-first century with now present-day applications including the complete variety of all kind of indications for surgery for pediatric urological pathology. This article aims to provide a comprehensive overview of current indications, techniques, and outcomes of laparoscopic transperitoneal surgery of the upper as well as of the lower urinary tract for urological pathology in the pediatric patient population.
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Affiliation(s)
- Philipp O Szavay
- Department of Pediatric Surgery, Lucerne Children's Hospital, Lucerne, Switzerland
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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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