A two-center experience with the exclusive use of laparoscopic transperitoneal nephrectomy for benign renal disease in children |
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Authors: | A A Mahomed C Hoare F Welsh C P Driver |
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Institution: | (1) Department of Paediatric Surgery, Royal Alexandra Hospital for Sick Children, 57 Dyke Road, Brighton, BN1 3JN, UK;(2) Department of Surgical Paediatrics, Royal Aberdeen Children’s Hospital, Aberdeen, Scotland, AB25 2ZN |
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Abstract: | Background This study aimed to evaluate a two-center experience with pediatric transperitoneal laparoscopic nephrectomy, specifically
focusing on the outcome parameters of operative time, complication, analgesic requirement, and postoperative stay.
Methods This ambispective study was conducted over a 4-year period between May 2001 and May 2005 in two tertiary pediatric surgical
centers. Data were prospectively recorded from an in-house expanded medical audit system (EMAS) and a Microsoft Excel database.
Information on patient demographics, operative time, complications, analgesic requirement, and length of hospital stay were
retrieved and analyzed.
Results A total of 30 consecutive patients with a mean age of 4.43 years (range, 3 months to 15 years) underwent laparoscopic nephrectomy.
All the patients underwent unilateral nephrectomy/nephroureterectomy for multidysplastic kidney (n = 12), reflux nephropathy (n = 13), pelvicoureteric junction obstruction (n = 4), or cystic disease of indeterminate cause (n = 1). The mean operative time was 93 ± 30 min. The principal hemostatic devices used were the Harmonic Scalpel (20 cases),
liga clips (5 cases), and hook diathermy and endoshears exclusively (4 cases). There were no conversions, but the intraoperative
complications of bleeding (n = 2), difficult location (n = 1), difficult extraction (n = 1), and requirement for a liver retractor (n = 2) were encountered. An additional five patients had problems in the immediate postoperative period, two of whom went on
to have long term difficulties with recurrent urinary tract infections resulting from a residual ureteric stump, which required
surgery. Nearly one-third of the patients required morphine for analgesia in the immediate postoperative period, with the
figure falling to 20% by day 1. The median postoperative hospital stay was 1 day (range, 0–16 days). At this writing, all
the patients remain under surveillance with a mean follow-up period of 2.88 years, and no patients have experienced complications
secondary to intraabdominal adhesions.
Conclusion Transperitoneal laparoscopic nephrectomy is technically feasible in most cases of benign renal disease. The intraoperative
complications are minimal, and recovery for most is robust. Two-thirds of the patients are discharged within 24 h. In this
study, narcotic analgesics were prescribed in about a one-third of all the cases for a limited period. Further problems may
be seen when refluxing ureters are incompletely excised. However, the transperitoneal approach does not mitigate against complete
excision because the exposure to the pelvis is adequate. At the midterm follow-up assessment, adhesive obstruction was not
encountered, confirming this approach as a tenable alternative to other laparoscopic approaches for nephrectomy. |
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Keywords: | Benign Laparoscopic nephrectomy Pediatric Retroperitoneal Transperitoneal |
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