Laparoscopy or retroperitoneoscopy: which is the best approach in pediatric urology?

Native nephrectomy in advanced pediatric kidney disease: indications, timing, and surgical approaches

In pediatric kidney failure, native kidneys may pose a risk to successful transplant outcomes. The indications and timing of native nephrectomy represent a controversial management decision. A lack of high-quality, outcomes-based data has prevented development of evidence-based guidelines for intervention. In this article, we review the published literature on medical indications for native nephrectomy and current knowledge gaps. In addition, we provide a surgical perspective regarding timing and approach.

Comparative study of different surgical approaches for treatment of UPJ obstruction according to the degree/severity of hydronephrosis factor

OBJECTIVE

To compare the efficacy of two different surgical approaches during and after pyeloplasty according to the degree/severity of hydronephrosis factor.

MATERIALS AND METHODS

Sixty child patients with UPJ obstruction admitted to our hospital from August 2019 to October 2021 were collected. Patients who underwent retroperitoneal laparoscopic pyeloplasty (RPLP) were enrolled into Group A (n = 20), while those who received transperitoneal laparoscopic pyeloplasty (TLP) were selected as Group B (n = 40). Clinical parameters, including gender, age, laterality of UPJ obstruction, degree/severity of hydronephrosis, body weight, operation time, drainage tube indwelling time, complete oral feeding time, and length of hospital stay, were compared between the two groups.

RESULTS

All 60 child patients were operated upon successfully without conversion to open surgery. There were no statistically significant differences in gender, age, laterality of UPJ obstruction, and body weight between the two groups, while the operation time of TLP was shorter than that of RPLP, indicating a statistically significant difference (P < 0.001). The differences in complete oral feeding time, drainage tube indwelling time, and length of hospital stay were statistically significant between the two groups, and RPLP was superior to TLP in terms of postoperative recovery time (P < 0.001). A stratified comparison showed that there were no statistically significant differences in anteroposterior diameter ≤ 20 mm, while there were statistically significant differences in anteroposterior diameter >20 mm. Hydronephrosis is reviewed after 3 months of the operation, degree/severity of hydronephrosis have been reduced.

CONCLUSION

Both RPLP and TLP are safe and feasible in the treatment of UPJ obstruction, and their overall surgical effects are equivalent. For child patients with anteroposterior diameter ≤ 20 mm, RPLP is available, while patients with anteroposterior diameter >20 mm, TLP is recommended.

Perioperative morbidity of paediatric laparoscopic nephrectomy by transperitoneal and retroperitoneal approaches- any difference?

AIM

Minimal invasive approaches for paediatric nephrectomy include transperitoneal (TP) and retroperitoneal (RP); both having advantages and disadvantages. We aimed to ascertain if there was any difference in perioperative morbidities between these two approaches.

METHODS

We performed a retrospective review of laparoscopic TP and RP nephrectomies performed in our institution over 10 years from May 2009 till May 2019. Outcome measures included intraoperative complications, prolonged requirement of opioid analgesics (more than 24 h), hospital stay, incidence of wound infection and urinary tract infections. Data were analysed using Fisher's exact test and Mann Whitney test.

RESULTS

A total of 152 nephrectomies were performed in 139 patients; 81 were TP and 71 were RP. Age ranged from 8 months to 16 years. Median hospital stay was 2 days in both groups. There were no intraoperative complications. Outcome measures were sub-categorised as follows. Requirement of opioid analgesia for more than 24 h was documented in 2 patients in each group, leading to longer hospital stay of 3 days. A febrile urinary tract infection requiring antibiotics was detected in 4; 1 in TP and 3 in RP. Wound infection requiring antibiotics occurred in 1 patient (in RP group). No statistically significant difference was found between the two groups in any of the subcategories.

CONCLUSION

TP and RP nephrectomy have similar perioperative morbidity. The decision to utilise either approach should be dependent on the surgeon's skills and experience and appropriately tailored to individual patient needs.

Single-site retroperitoneoscopy in pediatric metastatic lymphadenopathy

BACKGROUND

Retroperitoneoscopic surgery (RS) is increasingly used for the diagnosis, staging, and treatment of solid tumors, but rarely in pediatric surgical oncology for retroperitoneal lymph node dissection (RPLND). Herein, we use single-site RS for RPLND in children and compare the perioperative outcomes with those for the transperitoneal laparoscopic approach (TPLA).

METHODS

A single institution retrospective chart review was performed for patients undergoing single-site RS and TPLA (January 2018 till June 2019). We compared patient demographics, diagnoses, operative times, complications, postoperative analgesia, and length of hospital stay between both groups.

RESULTS

Eight patients (median age of 16.5 years) undergoing single-site RS for RPLND and five patients (median age 17 years) undergoing TPLA RPLND were compared. Groups were comparable in age, median operative duration (232 vs 234 min, p = 0.77), and complications (1 vs 1, p = 0.72). Median postoperative hospital stay and total morphine equivalent doses used postoperatively were significantly lower in the RS group, (0.5 vs 2 days, [p = 0.03] and 0.1 vs 0.4 mg/kg [p = 0.01], respectively). Eight patients underwent ipsilateral modified template RPLND for paratesticular RMS (six single-site RS and two TPLA) and lymph node metastases were found in 50% of these patients. The rest were resections of metastatic lesions for germ cell tumor and neuroblastoma (two single-site RS and three TPLA).

CONCLUSIONS

Single-site RS is a safe and feasible technique in carefully selected pediatric surgical oncology patients. RS provides an excellent view of the retroperitoneum, requires less postoperative analgesia, and is associated with faster recovery.

LEVEL OF EVIDENCE RATING

IV.

Retroperitoneoscopic resection of a T11-L2 right-sided ganglioneuroma

Paraspinal tumors arising from the sympathetic chain include those on the ganglioneuroma-neuroblastoma spectrum. Accurate diagnosis often requires excision owing to the histopathologic heterogeneity of these tumors and the risk of false negative biopsy results. Choice of approach is dictated by location and extirpation is usually amenable to minimally invasive techniques. We present a patient whose paraspinal tumor included the T11-L2 vertebral body levels and was removed using a retroperitoneoscopic approach. This approach is rarely considered in pediatric general surgery and afforded a useful alternative to thoracoscopy or laparoscopy.