456 LAPARO-ENDOSCOPIC SINGLE SITE (LESS) NEPHRECTOMY FOR BENIGN UROLOGIC DISEASE IN CHILDREN

Abstract

You have accessJournal of UrologyPediatrics: Congenital Anomalies - Kidney & Ureter1 Apr 2012456 LAPARO-ENDOSCOPIC SINGLE SITE (LESS) NEPHRECTOMY FOR BENIGN UROLOGIC DISEASE IN CHILDREN Arun Srinivasan, Marcos Perez-Brayfield, Luis Muniz, Karinia Escudero, Bruce Broecker, and Andrew Kirsch Arun SrinivasanArun Srinivasan Atlanta, GA More articles by this author , Marcos Perez-BrayfieldMarcos Perez-Brayfield San Juan, PR More articles by this author , Luis MunizLuis Muniz San Juan, PR More articles by this author , Karinia EscuderoKarinia Escudero San Juan, PR More articles by this author , Bruce BroeckerBruce Broecker Atlanta, GA More articles by this author , and Andrew KirschAndrew Kirsch Atlanta, GA More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.524AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES To use Laparo-Endoscopic Single Site technique to perform nephrectomy in the pediatric patient population. METHODS We prospectively collected procedural and outcome data on 21 patients (24 renal units) undergoing LESS nephrectomy at two institutions. The patient population included 17 children who underwent unilateral nephrectomy, 1 underwent upper pole heminephrectomy and 3 underwent bilateral nephrectomy. Patients were positioned in modified lateral decubitus position for unilateral nephrectomy and supine for bilateral nephrectomy. We used a GelPOINT (Applied Medical, Rancho Santa Margarita, CA) multi-access port inserted through the umbilicus. A 2 cm semi-circular incision in the umbilicus was made along the inside edge of umbilicus extending from 3 - 6-o'clock position and vertical fascial incision is made in the midline. Under direct vision the GelPOINT port was inserted and pneumopertioneum was achieved. 3 ports were inserted through this for laparoscopic access. Extractions were performed through the same site. The specimen was morcellated if it was too large to be extracted intact. RESULTS Our patients were equally split between the two genders. The mean age was 6.1 years (range 3mo-17 years). All patients underwent procedures for a variety of non-malignant pathology (including 11 with obstructive uropathy, 3 with reflux nephropathy, 3 with residual MCDK and 4 with renal hypertension and chronic renal failure) with renal sizes ranging from 2.3 to 18 cm in size. Blood loss in these patients was estimated to be minimal. Mean procedural time including extraction was 71 minutes (40-110 minutes) for unilateral nephrectomy and 127 minutes (122-132 minutes) for bilateral nephrectomy. None of our patients were converted to either conventional laparoscopy or open procedures and there were no complications. In some cases, a 3 mm grasping instrument was placed through a separate puncture to retract the liver or spleen. Average in-hospital stay for patients after nephrectomy was 38 hours (25-72 hours). CONCLUSIONS Based on this multi-institutional prospective study, we believe that LESS surgery is an excellent surgical option particularly for children given the added advantage of a completely unseen scar. We believe the technique is safe and feasible in children undergoing nephrectomy for a variety of reasons regardless of the size of the kidney. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e186 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Arun Srinivasan Atlanta, GA More articles by this author Marcos Perez-Brayfield San Juan, PR More articles by this author Luis Muniz San Juan, PR More articles by this author Karinia Escudero San Juan, PR More articles by this author Bruce Broecker Atlanta, GA More articles by this author Andrew Kirsch Atlanta, GA More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...