Laparoscopic upper-pole nephroureterectomy in infants

Abstract

Objective: Report the results of laparoscopic upper-pole nephroureterectomy in infants. Materials and Methods: Six consecutive infants underwent 7 laparoscopic upper-pole nephroureterectomy. Pre and postoperative evaluation included renal sonography, voiding cystourethrogram and renal scintigraphy. All infants showed upper-pole exclusion. Surgery was performed through a transperitoneal approach with full flank position in all infants. Three or 4 ports were used according to the necessity of retracting the liver. The distal ureter was ligated close to the bladder whenever reflux was present and the dysplastic upper-pole was divided with the help of an electrocautery. Data regarding operative time, postoperative use of analgesics, time to resume oral feeding, hospital stay and tubular function were collected and analyzed. Results: All procedures were concluded as planned. Mean operative time was 135 min. One patient underwent staged bilateral upper-pole nephrectomy. There were no complications and the postoperative hospital stay was 48 hours in 5 procedures and 24 hours in 2 procedures. Pain medication was required only in the first day. Renal tubular function showed improvement in half of the cases. Conclusion: Laparoscopic partial nephrectomy is a safe and feasible procedure in infants. Due to the magnification provided by the lenses, a better vision of the structures is achieved, facilitating selective dissection of vascular upper-pole, renal parenchyma and distal ureter. This approach is less damaging to the lower pole, and is associated to low morbidity and a short hospital stay.

Heminephrectomy in Adults: A Systematic Review with Cumulative Analysis

“…All the studies agreed that the operation had resolved the patients’ presenting complaint. Previous studies in the paediatric population have reported similar outcomes [39, 40]. This emphasises that the operation, regardless of the technique, is successful and results in good patient treatment in symptom resolution, mirroring that of the paediatric population.…”

Laparoscopic management and outcomes in non-functioning moieties of duplex kidneys in children

“…However, it must be stressed that this procedure does carry risks, and should only be attempted by an experienced laparoscopic surgeon. Magnification makes selective pole dissection safe and precise, promotes sectioning of the distal ureter without additional incisions, and minimizes trauma to the other pole [15]. It has all the advantages of minimally invasive surgery in terms of cosmesis and early recovery.…”

“…There is reduced risk of injury to intraabdominal organs and quicker recovery [14]. Previous studies have reported a high incidence of peritoneal tears, limiting the use of the retroperitoneal approach to older children [15,16]. Laparoscopic partial nephroureterectomy is technically difficult and has a steep learning curve [3,8,9,17].…”

“…We found only one published series, by Miranda et al [15], which has assessed postoperative tubular function. It is currently our practice to obtain a DMSA scan, in all patients, 6 months after the operation.…”

“…There have been reports of peritoneal tears in two series [15,16], duodenal perforation in two series [7,19] and omental hernia in one series [3] of laparoscopic partial nephrectomy. We did not encounter these complications.…”