Laparoscopic Dismembered Pyeloplasty in Children Younger Than 2 Years

Abstract

This study suggests that laparoscopic pyeloplasty can now be performed in young children with good results.

Laparoscopic Pyeloplasty - Our Early Experience

“…Although adhesions may occur with urological laparoscopic procedures, the incidence appears lower than would be expected with open exploration 14 . Laparoscopic dismembered pyeloplasty is an acceptable option for UPJO in infants and younger children [13][14][15] . A recent report has demonstrated that laparoscopic dismembered pyeloplasty is technically possible in infants younger than 6 months 16 .…”

“…The difficulty in performing LP that we found at the beginning of the series was in performing the anastomosis, but we completed with patience with relatively longer operating time but other author converted to open operation for difficulty in anastomosis 17 . The use of 3-mm trocars are recommended to perform this procedure 15,18 , but we used one 10 mm for camera port and two 5 mm port as we are lacking 5 mm telescope and 3 mm port and grasper as well. Double J catheter placement during LP is another recommendation, since it prevents urinary leakage and obviates the need for a perianastomotic drain 13,19 .…”

Laparoscopic renal surgery in infants and children: is it a feasible and safe procedure for all pediatric age groups?

“…The initial access was made with a Veress needle, except in the few cases with previous abdominal surgery or marked obesity, in which a Hasson (open) technique was used. In 4 cases, Details of the surgical technique have been previously described, but some technical points should be stressed (9)(10)(11)(15)(16)(17). In the UPN, after exposing the hilum, the diseased ureter is divided distally, almost always at the level of the iliac vessels, preserving the normal ureter.…”

“…Reconstructive and ablative renal procedures have been reported with increasing frequency, with safety and success (9)(10)(11)(12)17). The presence of malignant pathology was one of the few limitations yet to be transposed in pediatric renal laparoscopy.…”

“…Nevertheless, there are very few works addressing the possible limitations deriving from the small corporeal size in the application of the method (10)(11)(12). The primary objective of this study was to review indications, feasibility and safety in 3 pediatric age groups, in order to determine if younger (hence smaller) children are at an increased risk for conversion or complications when undergoing a laparoscopic renal procedure.…”