A clinical series of laparoscopic nephrectomy, nephroureterectomy and heminephroureterectomy in the pediatric population

PURPOSE: Laparoscopic techniques have enabled less invasive surgery in pediatric urology. We report our experience with laparoscopic nephrectomy, nephroureterectomy and heminephroureterectomy in 26 children, and evaluate our series to establish the safety and efficacy of such procedures for benign disease. MATERIALS AND METHODS: Laparoscopic procedures were done in 15 girls and 11 boys 4 months to 11 years old (mean age 37) during a 23-month period. Laparascopic surgery consisted of nephrectomy in 14 (1 horseshoe kidney), nephroureterectomy in 6 and laparoscopic heminephroureterectomy in 6 cases. RESULTS: Mean overall operative time for the laparoscopic procedures was 165 minutes (range 43 to 355). Blood loss was less than 5 cc in all cases and there were no intraoperative complications in our series. Overall postoperative analgesic administration during hospitalization was 0.20 mg./kg. morphine sulfate and 19 mg./kg. acetaminophen as well as 0.9 mg./kg. codeine in 6 patients who did not receive morphine. Three children were discharged home on the day of surgery, while 17, 3, 1 and 2 were discharged home on postoperative days 1, 2, 4 and 5, respectively. Cosmetic results were excellent in all cases. CONCLUSIONS: Nephrectomy, nephroureterectomy and heminephroureterectomy may be performed for benign disease in children using laparoscopy with minimal morbidity, minimal postoperative discomfort, improved cosmesis and a short hospital stay. It may even be done as an outpatient procedure.