Abstract
Background
Laparoscopic nephrectomy in children has gradually become a reasonable alternative to open nephrectomy and, besides, a retroperitoneal approach seems more logical than transperitoneal approach to perform nephroureterectomy for benign disease, as in open surgery. To further reduce the access-related complications, we propose a retroperitoneal one trocar-assisted nephrectomy (OTAN). We report our experience with minimally invasive OTAN for the treatment of benign renal disease.
Methods
A total of 27 OTANs were performed at our institution between 2003 and 2009. The median patient age was 7.6 (range, 2–32 months). Indications for unilateral nephrectomy were multicystic dysplastic kidney (MCDK) in 23 cases (85.2%), dysplastic kidney in 3 cases (11.1%), and reflux nephropathy in 1 case (3.7%).
Results
The median operative time from the initial incision to skin closure was 60 min. Perioperative transfusion was not required in any cases. No major perioperative complications developed. Conversion to open surgery was necessary in four cases (14.8%): in three cases for a small working space arising from a peritoneal perforation, and in one case for a difficult visualization of the parenchyma (renal fusion not detected by preoperative ultrasound evaluation). Most patients were allowed oral intake on postoperative day 1. The median hospital stay was 2 (range, 2–3) days; the cosmetic results were excellent. Convalescence was uneventful in all patients.
Conclusions
Although the indications for a nephrectomy in case of benign disease remain limited, when a little child has small, poorly functioning kidneys that must be removed, a one trocar-assisted approach for nephrectomy is usefully a safe and effective treatment choice. The procedure can be easily performed through a small incision with minimal morbidity, comparable operative time, and excellent cosmesis without excessive postoperative pain issues, allowing early discharge home.
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References
Ku JH, Byun SS, Choi H, Kim HH (2005) Laparoscopic nephrectomy for congenital benign renal disease in children in comparison with adults. Acta Paediatr 94:1752–1755
Valla JS, Guillonneau B, Montupet P, Geiss S, Steyaert H, Leculee R, El Ghoneimi A, Dahman M, Volpe P (1996) Retroperitoneal laparoscopic nephrectomy in children: preliminary report of 18 cases. Eur Urol 30:490–493
Tadini B, Repetto L, Guarino N, Lace R, Marras E, Bianchi M (2006) Retroperitoneoscopic renal surgery in children: our experience. J Laparoendosc Adv Surg Tech A 16:305–307
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
Clayman RV, Kavoussi LR, Soper NJ, Dierks SM, Meretyk S, Darcy MD, Roemer FD, Pingleton ED, Thomson PG, Long SR (1991) Laparoscopic nephrectomy: initial case report. J Urol 146:278–282
Kim C, McKay K, Docimo SG (2009) Laparoscopic nephrectomy in children: systematic review of transperitoneal and retroperitoneal approaches. Urology 73(2):280–284
Sherburne R, Figenshau RS, Yu MK (2001) Laparoscopic nephrectomy and nephroureterectomy in the pediatric patient. Urol Clin N Am 28:53–60
Steyaert H, Valla JS (2005) Minimally invasive urologic surgery in children: an overview of what can be done. Eur J Pediatr Surg 15(5):307–313
Diamond DA, Price HM, McDougall EM, Bloom DA (1995) Retroperitoneal laparoscopic nephrectomy in children. J Urol 153:1966–1968
Guillonneau B, Ballanger P, Lugagne PM, Valla JS, Vallancien G (1991) Laparoscopic versus lumboscopic nephrectomy. Eur Urol 29:288–291
Kobashi KC, Chamberlin DA, Rajpoot D, Shanberg AM (1998) Retroperitoneal laparoscopic nephrectomy in children. J Urol 160:1142–1144
Lima M, Tursini S, Ruggeri G, Gargano T, Libri M, Domini M (2007) One trocar assisted pyeloplasty (OTAP): initial experience and codification of a technique. Pediatr Med Chir 29(2):108–111
Valla JS (2007) Retroperitoneoscopic surgery in children. Semin Pediatr Surg 16(4):270–277
El-Ghoneimi A, Valla JS, Steyaert H, Aigrain Y (1998) Laparoscopic renal surgery via a retroperitoneal approach in children. J Urol 160:1138–1141
Disclosures
Drs. Lima Mario, Ruggeri Giovanni, Molinaro Francesco, Gargano Tommaso, Gregori Giulo, and Randi Beatrice have no conflicts of interest or financial ties to disclose.
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Lima, M., Ruggeri, G., Molinaro, F. et al. One-trocar-assisted nephrectomy (OTAN): initial experience and codification of a technique. Surg Endosc 26, 1165–1169 (2012). https://doi.org/10.1007/s00464-011-1998-1
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DOI: https://doi.org/10.1007/s00464-011-1998-1