Minimally invasive surgery for urologic disease in children

Abstract

This article is a comprehensive review of the current indications and recent literature pertaining to laparoscopic techniques in pediatric urology. Basic concepts such as instrumentation, anesthetic considerations, and complications are reviewed. Specific techniques and indications are also explored. As the field of pediatric urology continues to expand, it still lags behind adult urology. With improvements in technology, however, and with new surgeons entering the field with a basic laparoscopic background, pediatric urologic laparoscopy continues to progress. Currently, procedures such as laparoscopic exploration for undescended testicles and laparoscopic nephrectomy are accepted as the 'gold standard', and are performed at most institutions. Other procedures, such as laparoscopic pyeloplasty and laparoscopic reconstructive surgery, have only recently been introduced and are primarily available at centers with surgeons experienced in laparoscopy. It is our hope that minimally invasive surgical approaches to urologic conditions will become available to all children and become commonplace at most institutions.

Laparoscopic nephroureterectomy for Wilms' tumor: Oncologic considerations

“…From a technical standpoint, a nephrectomy can be achieved laparoscopically with minimal complications to surrounding structures. With the advent of minimally invasive surgical techniques for benign renal disease in children, surgeons are becoming increasingly familiar with this approach, and multiple reports have established minimally invasive surgery as a reasonable approach with clinical benefit [4][5][6][7]. In using such techniques, our case demonstrates that a minimally invasive approach can be applied to the treatment of Wilms' tumor.…”

“…There have been no reported complications, and tumor rupture has not occurred. In addition, there are preliminary but encouraging data that a laparoscopic approach to nephrectomy in benign disease is associated with decreased lengths of stay and analgesic requirements in the pediatric patient [4][5][6][7]. In the child with cancer, there is an added theoretical benefit in that a laparoscopic approach may hasten recovery and thereby reduce the time required to begin or reinstitute chemo-or radiotherapy postoperatively.…”

Weight-Adapted Surgical Approach for Laparoendoscopic Single-Site Surgery in Pediatric Patients Using Low-Cost Reusable Instrumentation: A Prospective Analysis

“…[2][3][4][5] The aim to further reduce invasiveness of surgical approaches has led to the evolution of a variety of techniques such as single-incision laparoscopic surgery, single-incision pediatric endosurgery, LESS, or natural orifice translumenal endoscopic surgery (NOTESÔ; American Society for Gastrointestinal Endoscopy [Oak Brook, IL] and Society for American Gastrointestinal and Endoscopic Surgeons [Los Angeles, CA]) in trying to achieve the common goal of scarless surgery. The development of these surgical techniques would not have been possible without the synchronous advancements in the development of less invasive instrumentation for all aspects of endoscopic surgery.…”

Two decades of minimally invasive pediatric surgery—taking stock

“…The era after 1990 saw the rapid integration of MIS to all fields of pediatric surgery, so much so that today, it is an integral part of pediatric surgical practice. A few attempts have however been made both previously and in the recent past, to delineate the status of MIS in general surgery and pediatric urology [18][19][20][21][22][23][24]. However, a consolidated opinion about the current status of minimally invasive surgery from a wide group of current pediatric surgeons is absent in literature.…”