Pediatric UrologyRetroperitoneal Laparoscopic Heminephrectomy in Duplex Kidney in Infants and Children: A 15-Year Experience
Introduction
Partial nephrectomy is a well-established option for the treatment of nonfunctioning renal moieties in duplex kidneys. Most indications of heminephrectomies in duplex kidneys are represented by high-grade reflux in lower moieties, and nonfunctioning upper moieties caused by ureterocele or ectopic distal implantation of the ureter. Even though laparoscopy has become the standard approach for total nephrectomy in children [1], minimally invasive techniques have not expanded so widely in the paediatric surgical community for heminephrectomies. Now, 15 yr after the first report of a laparoscopic partial nephrectomy in a child [2], the technique seems to remain confined to the hands of experienced teams, with a limited number of reports including relatively few cases.
Partial nephrectomy is a complex procedure, with a risk of urine leak, haemorrhage, and vascular injuries leading to functional loss of the remaining moiety [3]. Some reports have questioned the superiority of the laparoscopic technique in terms of length of procedure [4] and incidence of complications [5]. We report our experience with retroperitoneal laparoscopic partial nephrectomy in a nonselected population of infants and children over a 15-yr period.
Section snippets
Methods
We retrospectively reviewed all consecutive cases of partial nephrectomy performed through retroperitoneoscopy in our department. A total of 48 retroperitoneoscopic heminephrectomies (36 upper-pole and 12 lower-pole nephrectomies) were performed between 1993 and 2007, at a median age of 8.6 mo (range 1.5–89). These were unselected consecutive cases, no case of partial nephrectomy having been performed by open conventional surgery since 1999 in our unit. Forty-seven of the 48 procedures were
Results
The median duration of surgery was 120 min (range 70–215 min) with a slight tendency to decrease with experience (r2 = 0.23) (Fig. 1). Most children restarted feeding the same day as surgery (n = 24) or the day after (n = 22). The median length of hospital stay was 3 d (range 2–13 d), with 24 children discharged at day 2 and 13 at day 3 postoperatively.
Discussion
Although minimally invasive techniques have proven beneficial in several indications in adults and children, it seems that the diffusion of laparoscopic partial nephrectomy remains limited to centres with advanced laparoscopic experience. This may be related to the procedure's high level of technical difficulty combined with a relatively small number of indications, but also to a lack of evidence regarding the true benefits of the procedure. Although a few pioneering centres have reported on
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