World Journal of Urology

, Volume 34, Issue 7, pp 939–948 | Cite as

A comparison between laparoscopic and retroperitoneoscopic approach for partial nephrectomy in children with duplex kidney: a multicentric survey

  • Ciro EspositoEmail author
  • Maria Escolino
  • Go Miyano
  • Paolo Caione
  • Fabio Chiarenza
  • Giovanna Riccipetitoni
  • Atsuyuki Yamataka
  • Antonio Savanelli
  • Alessandro Settimi
  • Francois Varlet
  • Dariusz Patkowski
  • Mariapina Cerulo
  • Marco Castagnetti
  • Holger Till
  • Rosaria Marotta
  • Angela La Manna
  • Jean-Stephane Valla
Original Article



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.


Partial nephrectomy Duplex kidney Children Complications 


Authors’ contribution

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.

Ethical approval

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.


  1. 1.
    Janetschek G, Seibold J, Radmayr C, Bartsch G (1997) Laparoscopic heminephroureterectomy in pediatric patients. J Urol 158:1928–1930CrossRefPubMedGoogle Scholar
  2. 2.
    Yao D, Poppas DP (2000) A clinical series of laparoscopic nephrectomy, nephroureterectomy and hemi-nephroureterectomy in the pediatric population. J Urol 163:1531–1535CrossRefPubMedGoogle Scholar
  3. 3.
    Singh R, Wagener S, Chandran H (2010) Laparoscopic management and outcomes in non- functioning moieties of duplex kidneys in children. J Pediatr Urol 6:66–69CrossRefPubMedGoogle Scholar
  4. 4.
    El-Ghoneimi A (2003) Paediatric laparoscopic surgery. Curr Opin Urol 13(4):329–335CrossRefPubMedGoogle Scholar
  5. 5.
    Ehrlich RM, Gershman A, Fuchs G (1994) Laparoscopic renal surgery in children. J Urol 151:735–739PubMedGoogle Scholar
  6. 6.
    Valla JS, Breaud J, Carfagna L, Tunsini S, Steyaert H (2003) Treatment of ureterocele on duplex ureter: upper pole nephrectomy by retroperitoneoscopy in children based on a series of 24 cases. Eur Urol 43:426–429CrossRefPubMedGoogle Scholar
  7. 7.
    Jordan GH, Winslow DH (1993) Laparoendoscopic upper pole partial nephrectomy with ureterectomy. J Urol 150:940–943PubMedGoogle Scholar
  8. 8.
    Miyazato M, Hatano T, Miyazato T, Kagawa H, Yonou H, Ogawa Y (2000) Retroperitoneoscopic heminephrectomy of the right upper collecting system emptying into an ectopic ureterocele in a 5-years-old girl: a case report. Hinyokika Kiyo 46:413–416PubMedGoogle Scholar
  9. 9.
    Miranda LM, Oliveira-Filho AG, Carvalho PT, Ungersbock E, Olimpio H, Bustorff-Silva JM (2007) Laparoscopic upper pole nephroureterectomy in infants. Int Braz J Urol 33:87–93CrossRefPubMedGoogle Scholar
  10. 10.
    Le Clair MD, Vidal I, Suply E et al (2009) Retroperitoneal laparoscopic heminephrectomy in duplex kidney in infants and children: a 15-year experience. Eur Urol 56(2):385–389CrossRefGoogle Scholar
  11. 11.
    Castellan M, Gosalbez R, Carmack AJ, Prieto JC, Perez-Brayfield M, Labbie A (2006) Transperitoneal and retroperitoneal laparoscopic heminephrectomy—What approach for which patient? J Urol 176:2636–2639CrossRefPubMedGoogle Scholar
  12. 12.
    Marszalek M, Chromecki T, Al-Ali BM et al (2011) Laparoscopic partial nephrectomy: a matched-pair comparison of the transperitoneal versus the retroperitoneal approach. Urology 77:109–113CrossRefPubMedGoogle Scholar
  13. 13.
    Elashry OM, Wolf JS Jr, Rayala HJ, McDougall EM, Clayman RV (1997) Recent advances in laparoscopic partial nephrectomy: comparative study of electrosurgical snare electrode and ultrasound dissection. J Endourol 11:15–22CrossRefPubMedGoogle Scholar
  14. 14.
    Jackman SV, Caddeddu JA, Chen RN et al (1998) Utility of the harmonic scalpel for laparoscopic partial nephrectomy. J Endourol 12:441–444CrossRefPubMedGoogle Scholar
  15. 15.
    Esposito C, Iaquinto M, Escolino M et al (2014) Is retroperitoneoscopic renal ablative surgery easier and safer using a new hemostatic device compared with clips and monopolar coagulation? A comparative study. Minerva Urol Nefrol 66:101–105PubMedGoogle Scholar
  16. 16.
    Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications. a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205–213CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Cabezali D, Maruszewski P, Lopez F, Aransay A, Gomez A (2013) Complications and late outcome in transperitoneal laparoscopic heminephrectomy for duplex kidney in children. J Endourol 27(2):133–138CrossRefPubMedGoogle Scholar
  18. 18.
    Mushtaq I, Haleblian G (2007) Laparoscopic heminephrectomy in infants and children: first 54 cases. J Pediatr Urol 3(2):100–103CrossRefPubMedGoogle Scholar
  19. 19.
    Piaggio L, Franc-Guimond J, Figueroa TE, Barthold JS, Gonzalez J (2006) Comparison of laparoscopic and open partial nephrectomy for duplication anomalies in children. J Urol 175:2269–2273CrossRefPubMedGoogle Scholar
  20. 20.
    Robinson BC, Snow BW, Cartwright PC, DeVries CR, Hamilton BD, Anderson JB (2003) Comparison of laparoscopic versus open partial nephrectomy in a pediatric series. J Urol 169:638–640CrossRefPubMedGoogle Scholar
  21. 21.
    Gao Z, Wu J, Lin C, Men C (2011) Transperitoneal laparoscopic heminephrectomy in duplex kidney: our initial experience. Urology 77(1):231–236CrossRefPubMedGoogle Scholar
  22. 22.
    Miyano G, Takahashi T, Nakamura H et al (2013) Retroperitoneoscopic nephrectomy/heminephrectomy in children planned, performed and managed by supervised senior pediatric surgical trainees. J Laparoendosc Adv Surg Tech A 23:723–727CrossRefPubMedGoogle Scholar
  23. 23.
    Wallis MC, Khoury AE, Lorenzo AJ et al (2006) Outcome analysis of retroperitoneal laparo- heminephrectomy in children. J Urol 175:2277–2282CrossRefPubMedGoogle Scholar
  24. 24.
    Lee RS, Retik AB, Borer JG et al (2005) Pediatric retroperitoneal laparoscopic partial nephrectomy: comparison with an age matched cohort of open surgery. J Urol 174:708–711CrossRefPubMedGoogle Scholar
  25. 25.
    El Ghoneimi A, Farhat W, Bolduc S, Bagli D, Mclorie G, Khoury A (2003) Retroperitoneal laparoscopic vs open partial nephroureterectomy in children. BJU Int 91:532–535CrossRefPubMedGoogle Scholar
  26. 26.
    El-Ghoneimi A, Valla JS, Steyaert H, Aigrain Y (1998) Laparoscopic renal surgery via a retroperitoneal approach in children. J Urol 160:1138–1141CrossRefPubMedGoogle Scholar
  27. 27.
    Schneider A, Ripepi M, Henry-Florence C, Geiss S (2010) Laparoscopic transperitoneal partial nephrectomy in children under 2 years old: a single-centre experience. J Pediatr Urol 6(2):166–170CrossRefPubMedGoogle Scholar
  28. 28.
    Dingemann C, Petersen C, Kuebber JF, Ure BM, Lacher M (2013) Laparoscopic transperitoneal heminephrectomy for duplex kidneys in infants and children: a comparative study. J Laparoendosc Adv Surg Tech A 23(10):889–893CrossRefPubMedGoogle Scholar
  29. 29.
    You D, Bang JK, Shim M, Ryu DS, Kim KS (2010) Analysis of the late outcome of laparoscopic heminephrectomy in children with duplex kidneys. BJU Int 106(2):250–254CrossRefPubMedGoogle Scholar
  30. 30.
    Kawauchi A, Fujito A, Naito Y et al (2004) Retroperitoneoscopic heminephroureterectomy for children with duplex anomaly: initial experience. Int J Urol 11:7–10CrossRefPubMedGoogle Scholar
  31. 31.
    Borzi PA (2001) A comparison of the lateral and posterior retroperitoneoscopic approach for complete and partial nephroureterectomy in children. BJU Int 87:517–520CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2015

Authors and Affiliations

  • Ciro Esposito
    • 1
    Email author
  • Maria Escolino
    • 1
  • Go Miyano
    • 2
  • Paolo Caione
    • 3
  • Fabio Chiarenza
    • 4
  • Giovanna Riccipetitoni
    • 5
  • Atsuyuki Yamataka
    • 2
  • Antonio Savanelli
    • 1
  • Alessandro Settimi
    • 1
  • Francois Varlet
    • 6
  • Dariusz Patkowski
    • 7
  • Mariapina Cerulo
    • 1
  • Marco Castagnetti
    • 8
  • Holger Till
    • 9
  • Rosaria Marotta
    • 10
  • Angela La Manna
    • 10
  • Jean-Stephane Valla
    • 11
  1. 1.Department of Translational Medical Sciences“Federico II” University of NaplesNaplesItaly
  2. 2.Department of Pediatric General and Urogenital SurgeryJuntendo University School of MedicineTokyoJapan
  3. 3.Department of Pediatric UrologyBambino Gesù HospitalRomeItaly
  4. 4.Department of Pediatric SurgerySan Bortolo HospitalVicenzaItaly
  5. 5.Department of Pediatric SurgeryBuzzi HospitalMilanItaly
  6. 6.Department of Pediatric SurgeryCentre Hospitalier Universitaire, Hopital NordSaint-ÉtienneFrance
  7. 7.Department of Pediatric SurgeryWroclaw UniversityWroclawPoland
  8. 8.Department of Pediatric SurgeryUniversity of PaduaPaduaItaly
  9. 9.Department of Pediatric SurgeryMedical University of GrazGrazAustria
  10. 10.Department of PediatricsSecond University of NaplesNaplesItaly
  11. 11.Department of Pediatric SurgeryCHU LenvalNiceFrance

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