Early comparison of nephrectomy options in children (open, transperitoneal laparoscopic, laparo‐endoscopic single site (LESS), and robotic surgery)

Abstract

What ' s known on the subject? and What does the study add? For pediatric patients with nonfunctioning or poorly-functioning kidneys, laparoscopic nephrectomy has been shown to be a safe, viable option to traditional open surgery, with potential advantages of shorter hospital stays, decreased postoperative pain medication usage, and improved cosmesis.Technological advances have expanded the surgical options for nephrectomy beyond traditional laparoscopy to robot-assisted laparoscopy and, more recently, to laparoendoscopic single-site (LESS) surgery, which is also known as single incision laparoscopic surgery (SILS) or " belly-button " surgery.

Does robot‐assisted laparoscopic ileocystoplasty (RALI) reduce peritoneal adhesions compared with open surgery?

“…This direct comparison study shows the similarities in functional and surgical outcomes with either approach. This is consistent with other human and animal studies comparing these approaches for multiple other surgeries in adult and paediatric populations .…”

Minimally invasive nephrectomy for Wilms tumors in children – data from SIOP 2001

“…Laparoscopic procedures have become the standard approach for several operations on the upper urinary tract. This especially includes pyeloplasties and nephrectomies for benign pathologies [9,18,19]. In adults, MIS is regularly used for the surgical treatment of renal malignancies [20].…”

What’s the best minimal invasive approach to pediatric nephrectomy and heminephrectomy: conventional laparoscopy (CL), single-site (LESS) or robotics (RAS)?

“…This technique challenges the paradigm of CL to angulate the instruments for optimal working spaces. Instead it introduces significant ergonomic difficulties such as clashing (of the ports outside), crowding (of the instruments within the single port) and most important crossing of the instruments (6,12). The later means that all intuitive movements of CL become counterintuitive, just like crossing your hands when playing the piano.…”

“…The advantages for the surgeon include 3-D visualisation, tremor-free movements and most important the 360° wrist movement of the tip allowing for complex manoeuvres. Disadvantages are certainly sizes of instruments, loss of tactile feedback and costs (7,8,12).…”