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

Abstract

Purpose: Although laparoscopy is considered the mainstay for most renal procedures in adults, its role in the pediatric population is still controversial, especially for smaller children. We reviewed our experience in pediatric renal laparoscopic surgery in three pediatric age groups in an attempt to identify if age has an impact on feasibility and surgical outcomes. Materials and Methods: From November 1995 to May 2006, 144 pediatric laparoscopic renal procedures were performed at our institution. The charts of these patients were reviewed for demographic data, urologic pathology and surgical procedure, as well as perioperative complications and post-operative outcomes. The findings were stratified into 3 groups, according to patient age (A: < 1 year, B: 1 to 5 years and C: 6-18 years). Results: Median age of the patients was 4.2 years (42 days -18 years). We performed 54 nephrectomies, 33 nephroureterectomies, 19 upper pole nephrectomies, 11 radical nephrectomies, 22 pyeloplasties and 4 miscellaneous procedures. The 3 age groups were comparable in terms of the procedures performed. Conversion rates were 0%, 1.4% and 1.9% for groups A, B and C, respectively (p = 0.72). Incidence of perioperative complications was 5%, 8.2% and 7.8% for age groups A to C, respectively (p = 0.88). Conclusions: Most renal procedures can be performed safely by laparoscopy in the pediatric population, with excellent aesthetic and functional outcomes. The morbidity related to the procedure was minimal irrespective of the age group.

Análise prospectiva de nefrectomia seguindo modificação estética de técnica laparoscópica de aposição de trocarteres em população pediátrica

“…Francisco Dénes e cols publicaram casuística em 2008 com 144 pacientes (incluindo 87 nefrectomias/nefroureterectomias laparoscópicas), mostrando já naquela ocasião taxas de conversão para cirurgia convencional entre 0 e 1.9% e taxas de complicação entre 5 e 8,7% (38). O avanço tecnológico tanto em qualidade dos materiais laparoscópicos quanto definição dos equipamentos de videolaparoscopia sem dúvida auxiliam na tomada de decisão intraoperatória.…”