A comparison between laparoscopic and retroperitoneoscopic approach for partial nephrectomy in children with duplex kidney: a multicentric survey
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To compare the outcome of laparoscopic and retroperitoneoscopic approach for partial nephrectomy in infants and children with duplex kidneys.
Data of 102 patients underwent partial nephrectomy in a 5-year period using MIS procedures were analyzed. Fifty-two children underwent laparoscopic partial nephrectomy (LPN), and 50 children underwent retroperitoneoscopic partial nephrectomy (RPN). Median age at surgery was 4.2 years. Statistical analysis was performed using χ 2 test and Student’s t test.
The overall complications rate was significantly higher after RPN (15/50, 30 %) than after LPN (10/52, 19 %) [χ 2 = 0.05]. In LPN group, complications [4 urinomas, 2 symptomatic refluxing distal ureteral stumps (RDUS) and 4 urinary leakages] were conservatively managed. In RPN group, complications (6 urinomas, 8 RDUS, 1 opening of remaining calyxes) required a re-operation in 2 patients. In both groups no conversion to open surgery was reported. Operative time (LPN:166.2 min vs RPN: 255 min; p < 0.001) and hospitalization (LPN: 3.5 days vs RPN: 4.1 days; p < 0.001) were significantly shorter in LPN group. No postoperative loss of renal function was reported in both groups.
Our results demonstrate that RPN remains a technically demanding procedure with a significantly higher complications and re-operation rate compared to LPN. In addition, length of surgery and hospitalization were significantly shorter after LPN compared to RPN. LPN seems to be a faster, safer and technically easier procedure to perform in children compared to RPN due to a larger operative space and the possibility to perform a complete ureterectomy in refluxing systems.
KeywordsPartial nephrectomy Duplex kidney Children Complications
C. Esposito involved in data analysis, manuscript writing, manuscript editing; M. Escolino involved in data collection, manuscript writing; G. Miyano involved in data analysis; P. Caione involved in manuscript editing; F. Chiarenza involved in data analysis; G. Riccipetitoni involved in data analysis; A. Yamataka involved in data analysis; A. Savanelli involved in manuscript writing; A. Settimi involved in manuscript editing; F. Varlet involved in manuscript writing; D. Patkowski involved in data collection; M. Cerulo involved in manuscript writing; M. Castagnetti involved in data analysis; H. Till involved in data collection; R. Marotta involved in data collection; A. La Manna involved in data collection; and J.S. Valla involved in manuscript editing.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest and financial ties to disclose.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Being our study retrospective, formal consent is not required.