Partial nephrectomy for small children: Robot‐assisted versus open surgery

Ballouhey, Quentin; Binet, Aurélien; Clermidi, Pauline; Braik, Karim; Villemagne, T.; Cros, Jérôme; Lardy, H.; Fourcade, Laurent

doi:10.1111/iju.13466

Cited by 24 publications

(13 citation statements)

References 30 publications

(73 reference statements)

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“…Preventing recurrent UTIs in patients with duplex collecting system is one of the most effective ways to prevent renal scarring which progress to end stage renal disease [13]. According to the North American Pediatric Renal Trials and Collaborative Studies (NAPRTCS) and Europe, the most common cause of CKD in children are CAKUT (48-58%) [14,15].…”

Section: Discussionmentioning

confidence: 99%

Duplex Collecting System of Right Kidney in 3-Year-Old Child: A Case Report

Riani¹,

Nilawati²,

Duarsa³

et al. 2022

AJP

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Background: The duplex collecting system is one of the congenital anomalies of kidney and urinary tract. It occurs in 0.2-2% of the general population. It can remain asymptomatic or become symptomatic. Affected children may present with urinary tract infections. Treatment options include pharmacological and surgical approaches. Case: We reported a 3-year-old male child, who was referred to Sanglah Hospital with recurrent fever. From the physical examination, we found positive costovertebral angle tenderness. Urinalysis showed high leukocyte sediments (1655/field of view), positive urine culture (Enterococcus gallinarum), and decreased glomerular filtration rate (68.75 ml/minute/1.73 m 2 ). Ultrasonography of the right kidney showed two pelvicalyceal systems with severe hydronephrosis of upper moiety. The intravenous pyelography showed the drooping lily sign in the right kidney. We diagnosed the patient with a complicated urinary tract infection caused by Enterococcus gallinarum, duplex collecting system of right kidney, chronic kidney disease stage II. Antibiotics were administered due to complicated UTI. Open heminephrectomy was done. The patient was discharged in stable condition. Conclusion: The duplex collecting system may cause recurrent urinary tract infection. It can be a risk factor for renal scarring and cause chronic kidney disease. Comprehensive diagnostic workup and multidisciplinary management are needed to promote a good clinical outcome.

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Section: Discussionmentioning

confidence: 99%

Duplex Collecting System of Right Kidney in 3-Year-Old Child: A Case Report

Riani¹,

Nilawati²,

Duarsa³

et al. 2022

AJP

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“…In recent years, with the development of surgical techniques and surgical instruments in the medical industry, robotic[22] and tranumbilical single-hole[23] heminephrectomy have emerged, which have caused great repercussions in the industry. But research into these new technologies is scarce, and the increased finan-cial burden on patients requires further investigation.…”

Section: Discussionmentioning

confidence: 99%

Retroperitoneoscopic approach for partial nephrectomy in children with duplex kidney: A case report

Chen

Wang

et al. 2019

WJCC

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BACKGROUND Renal duplication is a common deformity of the urinary system, with an incidence of approximately 1/125 in children. Symptomatic patients with hydronephrosis, vesicoureteral reflux, or incontinence may require surgical interventions. Laparoscopy and retroperitoneoscopy are the two main accesses for partial nephrectomy. CASE SUMMARY A 9-year-old child was admitted to the hospital for hydronephrosis of the left kidney. Ultrasonography showed that the left kidney was larger, approximately 12.6 cm × 6.3 cm × 5.5 cm in size, with visible separation of the pelvis and an obviously separated lower portion. The upper segment of the left ureter was dilated (approximately 2.6 cm in width), and no significant dilation was observed in the middle and upper segments. The right kidney and ureter were normal. Primary diagnosis was left renal duplication malformation and hydronephrosis. Retroperitoneal laparoscopic nephrectomy and ureterectomy were performed. Intraoperative exploration revealed a dilated pelvis and thin renal parenchyma at the lower pole of the left kidney. The upper left kidney was smaller than normal, and the pelvis and ureter were larger than normal. The renal artery was blocked for 40 min. A hemolock was used to clamp down the kidney ureter, and a drainage tube was retained in the retroperitoneal cavity. The operation was uneventful, and the estimated amount of blood loss was 100 mL. Total abdominal drainage amount was 116 mL. The drainage tube was removed on postoperative day (POD) 3 and the patient was discharged on POD6. The pathological diagnosis confirmed the atrophy of the renal parenchyma, the dilation of the renal pelvis, hydronephrosis, and ureteral cystic dilation. CONCLUSION The retroperitoneoscopic approach for partial nephrectomy is feasible and effective in selective pediatric patients with a duplex kidney.

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“…Also, the postoperative pain control in total morphine equivalent intake was significantly greater in the open arm (1.08 vs. 0.52 mg/kg/day) P < 0.001. There was no significant difference in terms of operating time, complication rate, or renal outcomes (60).…”

Section: Case Specific Surgical Outcomesmentioning

confidence: 92%

Robotic Urologic Surgery in Infants: Results and Complications

Kim

2019

Front. Pediatr.

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Over the last 30 years, robotic surgery has evolved into the preferred surgical approach for many operative cases. Robotics has been associated with lower pain scales, shorter hospitalizations, and improved cosmesis ( 1 , 2 ). However, its acceptance in pediatrics have been hampered by longer operative times, smaller working space, and limited fine surgical instruments. Many find these challenges even more pronounced when performing robotic surgery in infants (i.e., children <1 year old). Although the data in infants is less robust, many studies have shown benefits similar to the adult population. Specifically, multiple reports of robotic surgery in infants have shown lower postoperative analgesic use. Additionally, hospital stays are shorter, which may lead to quicker return to work for parents and guardians. Multiple reports have shown low complication rates of robotic surgery in infants. When complications have occurred, they are usually Clavien Grade 1 and 2, with occasional grade 3. Often the complications are not from the robotic technique, but are linked to other factors such as the ureteral stents ( 3 , 4 ). Most importantly, the success rates of surgery are comparable to open surgery. This chapter will review indications for the most common urologic robotic surgeries performed in infants. Also, we will review reported results and complications of robotic surgery in children, with specific attention to the infant population. However, data focused only on infants is limited. Many studies have some infant patients, but their results are often mixed with all pediatric patients.

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Partial nephrectomy for small children: Robot‐assisted versus open surgery

Abstract: Robot-assisted heminephrectomy in small children seems to offer comparable renal outcomes with those of its standard open surgery counterpart. Specific technical adjustments are necessary, which typically increase the set-up time.

Cited by 24 publications

References 30 publications

Duplex Collecting System of Right Kidney in 3-Year-Old Child: A Case Report

Duplex Collecting System of Right Kidney in 3-Year-Old Child: A Case Report

Retroperitoneoscopic approach for partial nephrectomy in children with duplex kidney: A case report

Robotic Urologic Surgery in Infants: Results and Complications

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