Laparoendoscopic Single-site Nephrectomy in Pediatric Patients: Initial Clinical Series of Infants to Adolescents - 20/08/11

Doi : 10.1016/j.urology.2010.06.066

Chester J. Koh ^a,^b,^⁎ , Roger E. De Filippo ^a,^b, Andy Y. Chang ^a,^b, Brian E. Hardy ^a,^b, Andre Berger ^b, Manuel Eisenberg ^b, Mukul Patil ^b, Monish Aron ^b, Inderbir S. Gill ^{^{1
I. S. Gill was a stockholder in Hansen Medical and a consultant to EDAP TMS; and M. M. Desai was a consultant to Baxter and Hansen Medical.},}^b, Mihir M. Desai ^{^{1
I. S. Gill was a stockholder in Hansen Medical and a consultant to EDAP TMS; and M. M. Desai was a consultant to Baxter and Hansen Medical.},}^b
^a Division of Pediatric Urology, Children's Hospital Los Angeles, Los Angeles, California
^b USC Institute of Urology, University of Southern California Keck School of Medicine, Los Angeles, California

Reprint requests: Chester J. Koh, M.D., Division of Pediatric Urology, Children's Hospital Los Angeles, USC Institute of Urology, University of Southern California Keck School of Medicine, 4650 Sunset Boulevard, Mail Stop 114, Los Angeles, CA 90027

Résumé

Objectives

To present our initial clinical series of laparoendoscopic single-site (LESS) nephrectomy using an umbilical incision in children ranging from infants to adolescents. Laparoscopic surgery in pediatric urology is increasingly being performed for many intra-abdominal ablative procedures, such as nephrectomy for poorly functioning kidneys. We have previously reported our initial experience with LESS surgery in the adult population.

Methods

A total of 11 pediatric patients (age range 0.1-16.2 years, mean 5.7) underwent LESS nephrectomy using an umbilical incision. The perioperative clinical parameters were reviewed retrospectively.

Results

The 11 LESS pediatric nephrectomies were technically successful without conversion to conventional laparoscopy or open surgery. An accessory port was used in 5 of the cases early in the clinical series. Of the 11 patients, 2 were infants, aged 39 days and 3.5 months. The mean operative time was 139 minutes (range 85-205), and the mean hospital stay was 1.5 days (range 1.0-2.1). Complications included delayed hydrocele formation in 2 male patients.

Conclusions

The results of our study have shown that LESS nephrectomy using a single umbilical incision in pediatric patients is technically feasible with good outcomes. Additional studies are needed to evaluate the expected benefits of this novel technique. Also, miniaturization of currently available equipment is needed to adapt to the small working spaces available in the pediatric patient.

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