No abstract

Preoperative computer tomography (CT) guidance localization utilizing a percutaneous guidewire before thoracoscopic resection is safe and beneficial in children with pulmonary nodules less than 1 cm in size or located deep in the pleural surface. This paper describes a successful thoracoscopic resection of a little subpleural pulmonary metastasis of a Wilm's tumor in a 5-year-old child utilizing preoperative CT-guided wire localization of the lesion. The thoracoscopic procedure was performed with the use of two ports, the nodule was easily localized,and the pulmonary wedge resection was made by the use of an endo-GIA linear stapling device after guidewire removal. The operating time was 45 minutes and the chest tube was removed after 48 hours. The postoperative course was uneventful, and the child was discharged on postoperative day 5. This technique allows the surgeon to resect little pulmonary nodules, avoiding the need of more invasive procedures as standard thoracotomy without adjunctive morbidity and with good cosmetic results.

Rhabdomyosarcomas (RMS) of the kidney is extremely rare. We are reporting one case of embrional rhabdomyosarcoma localized in a child renal pelvis, focusing on the rarity of the site and role of imaging. An 8-years-old boy was admitted to the hospital with abdominal pain and hematuria. Ultrasonography revealed a right ureteropyelectasy including an echogenic image that extended from the renal pelvis towards inferior basin with no hypervascularization, simulating a clot. The urography-magnetic resonance imaging (Uro-MRI) showed two different components of the lesion: the first one simulating a clot; the second one detected in the papillary region and extended to the inferior calices having tumor-like features. A percutaneous ultrasound-guided renal biopsy revealed a botryoid embryonal rhabdomyosarcoma. The RMS is a complex childhood malignancy. This complexity is reflected in the radiological assessment that remains highly challenging and in the absense of treatment guidelines for unusual sites.

Anderson-Hynes dismembered ureteropyeloplasty has been the gold standard surgical treatment for ureteropelvic junction obstruction (UPJO) caused either by crossing renal vessel or by a stenotic junction in children. Nowadays it is still discussed which could be the best surgical approach. All the techniques actually used have the goal to improve functional outcome and to reach better results in terms of reducing traumatic damage, postoperative pain and therefore reduction of hospitalization. We are presenting our experience in the treatment of UPJO by open dismembered pyeloplasty with a minimal invasive approach using the Alexis ® (Applied Medical, Rancho Santa Margherita, CA) autostatic wound retractor.