An initial experience of 100 paediatric laparoscopic nephrectomies with transperitoneal or posterior prone retroperitoneoscopic approach

Abstract

The objective of this study was to evaluate the outcome of the initial 100 consecutive laparoscopic nephrectomies using a transperitoneal or a posterior prone retroperitoneoscopic approach. The medical records of 97 consecutive children who underwent laparoscopic nephrectomy between January 2000 and December 2003 were reviewed. Children having concomitant operative procedures were excluded from the study. Laparoscopy was performed by a transperitoneal (TP) or a posterior prone retroperitoneoscopic (PPR) approach based on the preference of the operating surgeon. A total of 100 procedures were successfully completed laparoscopically. Two children required conversion to open surgery. The median operating time was 112 min for the TP approach and 96 min for the PPR approach (P = 0.002). There was no significant difference in the analgesic requirements between the two groups. The rate of complications was similar, as was the length of hospital stay. This was despite the fact that the children in the TP group were somewhat older in age. In children having bilateral native kidney nephrectomy, peritoneal dialysis was successfully established within 48 h after surgery in the PPR group. Taking into account the heterogeneous nature of our group of patients, a reliable conclusion in regard to the difference in operative time, analgesic requirement or approach could not be ascertained. There is the suggestion however, that both the TP and PPR approaches for nephrectomy are equally applicable in children. The posterior prone retroperitoneoscopic approach may have an advantage in children who require peritoneal dialysis.

Update on the Minimally Invasive Approach in Paediatric Urology: Remote Help for Human Hands?

“…The feasibility of the laparoscopic approach and its safety and efficacy have been demonstrated [25,31,33,49,50]; however, the steep learning curve of laparoscopy, the technical difficulties related to two-dimensional vision, the compromised dexterity due to the well-known fulcrum effect, and the transmission and amplification of the surgeon's hand tremor have contributed to make laparoscopy a technique that takes considerable time to master. The robot-assisted technique has the potential to allow for wider adoption of MIS in paediatric urology.…”

Prone retroperitoneoscopy in treating complex renal vascular malformations

“…The PRP approach was used, as described by Gundeti et al [2]. In summary, the patient was placed in standard prone position with supports under lower chest and pelvis with the patient strapped down to the table.…”

Transperitoneal laparoscopic heminephroureterectomy in the pediatric population: A single-centre experience using a sealing device

“…7 The average duration of the LHNU, which was 222 minutes (180-330 minutes) in the last 20 years, 13 LHNU has the advantages of shorter hospitalization time, lower morbidity, lower complication rates and more satisfying cosmetic results compared with open surgery. 2,7,8,11,13 In the studies conducted with age-matched cohort groups, it was found out that the hospitalization time was shorter in LHNU carried out with transperitoneal or retroperitoneal approach compared with open surgery. 11 In their study, Boris et al noticed the significantly different average hospitalization times between open surgery and LHNU (2.7 and 5.1 days respectively).…”

“…2,11,13,14 In the LHNU operations of the right kidney, liver retraction and the use of the 3 rd working port to enable colon retraction in children over 3 kg was recommended. 8 Taking the differences of both left and right sides into consideration, it is useful to insert the 4th trocar on the right side for the liver retraction and for better exposure of the upper side of the kidney. Usage of the 4th trocar on the left side depends on the size of the spleen and on the preference of the surgeon.…”

“…1 The advantages of using transperitoneal laparoscopic approach are; achieving larger working space and easier access to the upper pole. 8,9 This study includes a retrospective evaluation of the outcomes of patients with a duplex collecting system, who were treated with transperitoneal LHNU.…”