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Pediatric single port transumbilical nephrectomy and nephroureterectomy.

Urbanowicz W, Sulisławski J, Wolnicki M - Cent European J Urol (2011)

Bottom Line: The incision scars were hidden inside the umbilicus.The advantages are shortened convalescence, excellent cosmetic results, and reduction of potential wounds complications.However, clear indication of single site laparoscopic procedures in children remains to be clarified.

View Article: PubMed Central - PubMed

Affiliation: Department of Pediatric Urology Collegium Medicum Jagiellonian University in Kraków, Poland.

ABSTRACT

Objective: To present seven cases of single incision laparoscopic nephrectomy and nephroureterectomy in children as a recent videoscopic innovation.

Patients and methods: Seven children with nonfunctioning kidneys, three with multicystic dysplastic kidneys, two with end-stage renal nephropathy due to vesicoureteral reflux, and two with giant hydronephrosis were qualified to nephrectomy or nephroureterectomy. The surgery was performed transperitoneally using single incision access laparoscopy. The operative time was in the range of 50-90 min.

Results: There were no intraoperative or postoperative complications. The patients were discharged on the third postoperative day. The incision scars were hidden inside the umbilicus.

Conclusions: Nephrectomy or nephroureterectomy using a single transumbilical port in children is a feasible and efficacious technique. The advantages are shortened convalescence, excellent cosmetic results, and reduction of potential wounds complications. However, clear indication of single site laparoscopic procedures in children remains to be clarified.

No MeSH data available.


Related in: MedlinePlus

An internal view while freeing a dysplastic kidney.
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Figure 0002: An internal view while freeing a dysplastic kidney.

Mentions: Under general anesthesia, the patients were placed in the supine position and a urethral Foley catheter was inserted. Subsequently, a semicircular 2.5-3 cm incision was made below the umbilicus, similarly as it is done while achieving access to the peritoneum using the Hasson technique. We have been using multi-channel 5-12 mm SILS™ Ports manufactured by Covidien™. To insert the port into the abdominal cavity we employed two forceps. Following the insertion of the multi-channel port, the insufflator was attached and pneumoperitoneum was achieved to the value of 10-12 mmHg. Subsequently, the patient was placed in the flank position with the kidney to be nephrectomized upwards. A 10 mm 30o telescope was used to visualize the operative field. Mobilization of the left or right colon using a dissector and scissors with articulating working heads (Endo Dissect™ and Endo Shear™, Covidien) allowed for identification of the kidneys and renal hilum (Fig. 2). The kidneys were retracted anterolaterally with the help of a flexible grasper and the hilar vessels were exposed. After complete mobilization in the three patients with multicystic dysplastic kidneys, the hypoplastic renal artery, renal vein, and ureter were sealed using Liga-Sure™ manufactured by Covidien. In the remaining patients, the vessels were clipped using a 5 mm rigid vascular stapler (Endo GIA ™ Vascular, Covidien) and the ureter proximal to the bladder was sealed using Liga-Sure. The ureters were followed to the distal part of the iliac vessels and divided close to the bladder in children with VUR. The blood loss was minimal and no patient required transfusion. There was no bleeding under the 5 mmHg intraperitoneal pressure, hence, it was decided that there was no need for drain insertion in any patient. The kidneys were removed through the infraumbilical incisions using a grasper simultaneously with the SILS port. The fascia and the subcutaneous tissue were sutured with 3-0 Vicryl (Ethicon) and the skin was closed with subcuticular stitches 4-0 vicryl. The skin around the incision was injected with 0.5% solution of bupivacaine in general doses appropriate for weight to achieve local anesthesia. The urethral catheter was left in situ until the following day.


Pediatric single port transumbilical nephrectomy and nephroureterectomy.

Urbanowicz W, Sulisławski J, Wolnicki M - Cent European J Urol (2011)

An internal view while freeing a dysplastic kidney.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3921752&req=5

Figure 0002: An internal view while freeing a dysplastic kidney.
Mentions: Under general anesthesia, the patients were placed in the supine position and a urethral Foley catheter was inserted. Subsequently, a semicircular 2.5-3 cm incision was made below the umbilicus, similarly as it is done while achieving access to the peritoneum using the Hasson technique. We have been using multi-channel 5-12 mm SILS™ Ports manufactured by Covidien™. To insert the port into the abdominal cavity we employed two forceps. Following the insertion of the multi-channel port, the insufflator was attached and pneumoperitoneum was achieved to the value of 10-12 mmHg. Subsequently, the patient was placed in the flank position with the kidney to be nephrectomized upwards. A 10 mm 30o telescope was used to visualize the operative field. Mobilization of the left or right colon using a dissector and scissors with articulating working heads (Endo Dissect™ and Endo Shear™, Covidien) allowed for identification of the kidneys and renal hilum (Fig. 2). The kidneys were retracted anterolaterally with the help of a flexible grasper and the hilar vessels were exposed. After complete mobilization in the three patients with multicystic dysplastic kidneys, the hypoplastic renal artery, renal vein, and ureter were sealed using Liga-Sure™ manufactured by Covidien. In the remaining patients, the vessels were clipped using a 5 mm rigid vascular stapler (Endo GIA ™ Vascular, Covidien) and the ureter proximal to the bladder was sealed using Liga-Sure. The ureters were followed to the distal part of the iliac vessels and divided close to the bladder in children with VUR. The blood loss was minimal and no patient required transfusion. There was no bleeding under the 5 mmHg intraperitoneal pressure, hence, it was decided that there was no need for drain insertion in any patient. The kidneys were removed through the infraumbilical incisions using a grasper simultaneously with the SILS port. The fascia and the subcutaneous tissue were sutured with 3-0 Vicryl (Ethicon) and the skin was closed with subcuticular stitches 4-0 vicryl. The skin around the incision was injected with 0.5% solution of bupivacaine in general doses appropriate for weight to achieve local anesthesia. The urethral catheter was left in situ until the following day.

Bottom Line: The incision scars were hidden inside the umbilicus.The advantages are shortened convalescence, excellent cosmetic results, and reduction of potential wounds complications.However, clear indication of single site laparoscopic procedures in children remains to be clarified.

View Article: PubMed Central - PubMed

Affiliation: Department of Pediatric Urology Collegium Medicum Jagiellonian University in Kraków, Poland.

ABSTRACT

Objective: To present seven cases of single incision laparoscopic nephrectomy and nephroureterectomy in children as a recent videoscopic innovation.

Patients and methods: Seven children with nonfunctioning kidneys, three with multicystic dysplastic kidneys, two with end-stage renal nephropathy due to vesicoureteral reflux, and two with giant hydronephrosis were qualified to nephrectomy or nephroureterectomy. The surgery was performed transperitoneally using single incision access laparoscopy. The operative time was in the range of 50-90 min.

Results: There were no intraoperative or postoperative complications. The patients were discharged on the third postoperative day. The incision scars were hidden inside the umbilicus.

Conclusions: Nephrectomy or nephroureterectomy using a single transumbilical port in children is a feasible and efficacious technique. The advantages are shortened convalescence, excellent cosmetic results, and reduction of potential wounds complications. However, clear indication of single site laparoscopic procedures in children remains to be clarified.

No MeSH data available.


Related in: MedlinePlus