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Laparoscopic retroperitoneoscopic nephrectomy and partial nephrectomy in children.

Al-Hazmi HH, Farraj HM - Urol Ann (2015 Apr-Jun)

Bottom Line: There were no intraoperative complications (surgical and anesthetic), and no significant blood loss was observed.The mean hospital stay was 2.5 days (1-5).Laparoscopic retroperitoneoscopic renal surgery can be carried out safely and effectively in children.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, Division of Urology, College of Medicine and King Khalid University Hospital, King Saud University, Saudi Arabia.

ABSTRACT

Objectives: The aim was to evaluate our experience in the retroperitoneal laparoscopic approach in total and partial nephrectomies in children.

Materials and methods: We retrospectively reviewed the medical records of 41 patients who underwent retroperitoneal laparoscopic total or partial nephrectomies performed in our center from 2004 to 2012. We looked at the demographic data, age at surgery, indication, operative time, surgical complications, conversion to open surgery and operative complications.

Results: Thirty-five total and six partial nephrectomies (upper pole) were performed. The mean age was 84 months (7-175). Vesicoureteric reflux, pelviureteric junction obstruction, and multicystic dysplastic kidney disease were the main underlying pathologies. The mean operative time was 158 min (60-280). There were no intraoperative complications (surgical and anesthetic), and no significant blood loss was observed. Conversion to open surgery was necessary in two cases caused by failure to progress due to difficult anatomy during the partial nephrectomies. No major postoperative complications were noted. The mean hospital stay was 2.5 days (1-5). A drain was used in 12 cases and was removed after a mean of 2 days.

Conclusions: Laparoscopic retroperitoneoscopic renal surgery can be carried out safely and effectively in children. Still, this procedure is more challenging and requires an excellent image of the retroperitoneal space, especially when partial nephrectomies are concerned.

No MeSH data available.


Related in: MedlinePlus

Multicystic dysplastic kidney after extraction
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Figure 3: Multicystic dysplastic kidney after extraction

Mentions: The procedures were performed using a lateral retroperitoneal approach, in the same way, as that described by El-Ghoneimi et al.[12] After general anesthesia, the patient was positioned laterally on the side of the table, with the operation side at a 90° angle to the table [Figure 1]. The first incision site was marked approximately 20 mm or one fingerbreadth from the tip of the 12th rib to place the camera. Another two 5 mm incision sites were made for the working elements, one in anterior axillary line a fingerbreadth above the top of the iliac crest and the other, at the costovertebral angle [Figure 2]. The 20 mm incision was opened in layers, and Gerota's fascia was opened under direct vision. A working space was created by gas insufflation and dissection using the camera after the introduction of the first 10 mm trocar. Next, the other two 5 mm trocars were introduced under direct vision using a sharp introducer. The dissection was completed while keeping the anterior surface of the kidney attached to the peritoneum, and the renal pedicle was approached posteriorly. Our anatomical landmarks were the psoas muscle at the bottom of the screen and the kidney at the top of the screen. The renal pedicle was identified, and then the renal artery and renal vein were clipped or coagulated by ligature. Next, the ureters were identified and dissected distally as possible before either being coagulated (if not refluxing) or ligated with the Endoloop (ENDOLOOP Ligature, Ethicon, Cincinnati, OH, USA). The anterior surface of the kidney was freed from the peritoneum and became freely mobile in the retroperitoneal space. The kidney was removed from the main port (20 mm) after we removed the 10 mm camera, and we used a 5 mm camera through one of the other trocar sites. The kidney was retrieved either directly through the trocar if it was small or after the evacuation of the hydronephrotic kidney or grossly large cyst of MCDK [Figure 3]. If the kidney was large, we placed it in a 10 mm extraction bag and then divided it under direct vision after pulling and opening the neck of the bag. We did not leave a drain unless we encountered difficulty during the dissection in the case of an inflamed kidney. Next, all of the trocars were removed, and the trocar sites were closed with interrupted sutures.


Laparoscopic retroperitoneoscopic nephrectomy and partial nephrectomy in children.

Al-Hazmi HH, Farraj HM - Urol Ann (2015 Apr-Jun)

Multicystic dysplastic kidney after extraction
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4374250&req=5

Figure 3: Multicystic dysplastic kidney after extraction
Mentions: The procedures were performed using a lateral retroperitoneal approach, in the same way, as that described by El-Ghoneimi et al.[12] After general anesthesia, the patient was positioned laterally on the side of the table, with the operation side at a 90° angle to the table [Figure 1]. The first incision site was marked approximately 20 mm or one fingerbreadth from the tip of the 12th rib to place the camera. Another two 5 mm incision sites were made for the working elements, one in anterior axillary line a fingerbreadth above the top of the iliac crest and the other, at the costovertebral angle [Figure 2]. The 20 mm incision was opened in layers, and Gerota's fascia was opened under direct vision. A working space was created by gas insufflation and dissection using the camera after the introduction of the first 10 mm trocar. Next, the other two 5 mm trocars were introduced under direct vision using a sharp introducer. The dissection was completed while keeping the anterior surface of the kidney attached to the peritoneum, and the renal pedicle was approached posteriorly. Our anatomical landmarks were the psoas muscle at the bottom of the screen and the kidney at the top of the screen. The renal pedicle was identified, and then the renal artery and renal vein were clipped or coagulated by ligature. Next, the ureters were identified and dissected distally as possible before either being coagulated (if not refluxing) or ligated with the Endoloop (ENDOLOOP Ligature, Ethicon, Cincinnati, OH, USA). The anterior surface of the kidney was freed from the peritoneum and became freely mobile in the retroperitoneal space. The kidney was removed from the main port (20 mm) after we removed the 10 mm camera, and we used a 5 mm camera through one of the other trocar sites. The kidney was retrieved either directly through the trocar if it was small or after the evacuation of the hydronephrotic kidney or grossly large cyst of MCDK [Figure 3]. If the kidney was large, we placed it in a 10 mm extraction bag and then divided it under direct vision after pulling and opening the neck of the bag. We did not leave a drain unless we encountered difficulty during the dissection in the case of an inflamed kidney. Next, all of the trocars were removed, and the trocar sites were closed with interrupted sutures.

Bottom Line: There were no intraoperative complications (surgical and anesthetic), and no significant blood loss was observed.The mean hospital stay was 2.5 days (1-5).Laparoscopic retroperitoneoscopic renal surgery can be carried out safely and effectively in children.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, Division of Urology, College of Medicine and King Khalid University Hospital, King Saud University, Saudi Arabia.

ABSTRACT

Objectives: The aim was to evaluate our experience in the retroperitoneal laparoscopic approach in total and partial nephrectomies in children.

Materials and methods: We retrospectively reviewed the medical records of 41 patients who underwent retroperitoneal laparoscopic total or partial nephrectomies performed in our center from 2004 to 2012. We looked at the demographic data, age at surgery, indication, operative time, surgical complications, conversion to open surgery and operative complications.

Results: Thirty-five total and six partial nephrectomies (upper pole) were performed. The mean age was 84 months (7-175). Vesicoureteric reflux, pelviureteric junction obstruction, and multicystic dysplastic kidney disease were the main underlying pathologies. The mean operative time was 158 min (60-280). There were no intraoperative complications (surgical and anesthetic), and no significant blood loss was observed. Conversion to open surgery was necessary in two cases caused by failure to progress due to difficult anatomy during the partial nephrectomies. No major postoperative complications were noted. The mean hospital stay was 2.5 days (1-5). A drain was used in 12 cases and was removed after a mean of 2 days.

Conclusions: Laparoscopic retroperitoneoscopic renal surgery can be carried out safely and effectively in children. Still, this procedure is more challenging and requires an excellent image of the retroperitoneal space, especially when partial nephrectomies are concerned.

No MeSH data available.


Related in: MedlinePlus