Laparoscopic retroperitoneal renal and adrenal surgery in children

Abstract

Objective To retrospectively assess the use of a retroperitoneal laparoscopic approach for simple nephrectomy and adrenalectomy in children. Patients and methods All retroperitoneal laparoscopic renal and adrenal procedures carried out in children and completed between 1993 and March 2000 were reviewed retrospectively. Analgesic requirements, hospital stay, complications and blood loss were reviewed. The technique is described in detail. Results Forty-eight retroperitoneal laparoscopic procedures were completed in 48 patients (mean age 5.5 years, range 0.5-16). The procedures included nephrectomy (22), nephroureterectomy (15), renal biopsy (six), cyst ablation (two) and simple adrenalectomy (three). In all, 11 procedures were undertaken in children aged <2 years. Forty-one (91%) of the children undergoing renal procedures were discharged in <24 h. Two patients underwent three adrenalectomies. Two children required conversion to open surgery, one undergoing a right-sided adrenalectomy and one a nephrectomy. The mean operative duration for nephrectomy and nephroureterectomy was 75 min, and for adrenalectomy was 115 min. Conclusion Renal and adrenal surgery in children is a safe and rapid procedure with retroperitoneal laparoscopy. The operative duration for nephrectomy and nephroureterectomy are frequently <1 h. In addition, laparoscopic surgery offers significant advantages in terms of cosmesis and a quicker recovery.

The anterior approach to retroperitoneoscopic adrenalectomy in children: Technique

“…This is not surprising, considering the relative rarity of benign adrenal disease in children, since neuroblastoma is the most common adrenal mass in children. In fact, specific to RPA in children we could only identify four cohort studies in the literature describing a total of 22 patients including 3 by lateral RPA [1,8,9] and 1 by posterior RPA [10]. Considering the few reports about children and the small cohorts usually described within those reports, we believe that our small cohort is nevertheless an important contribution since it highlights a novel approach that we enthusiastically suggest deserves more attention.…”

Dispelling Inhibition for Laparoscopic Surgery in Younger Children with Cushing’s Syndrome

“…In their series of 75 patients who underwent endoscopic adrenalectomy, they admitted that when compared on the basis of endocrine status almost all of the complications were found in patients with CS and nonfunctioning adrenal tumors. Shanberg's et al's [6] youngest patient of CS who underwent LA was 13 years old. In another series of 21 patients with adrenal disease who underwent LA, there were no cases of CS [7] .…”

Retroperitoneoskopische Nephrektomie bei einem Neugeborenen wegen Faktor-V-Leiden-Mutation und in utero vena cava inferior und Nierenvenenthrombose: erster Fallbericht

“…A review of the literature indicates the growing popularity of retroperitoneoscopic nephrectomy in the pediatric population [30][31][32][33][34][35][36][37]. Compared to transperitoneal laparoscopic nephrectomy there appear to be several advantages to the retroperitoneoscopic approach, such as direct access to the kidney without need for peritoneal entry or colonic mobilization, decreased the risk of visceral organ injury, previous abdominal surgery is not a contraindication and postoperative urinoma or hematoma collections are confined to the retroperitoneum.…”