Comparison of transumbilical laparoendoscopic single-site heminephroureterectomy versus conventional open surgery for children with duplex kidney

Abstract

Objective To compare the outcome of transumbilical laparoendoscopic single-site surgery with conventional open surgery for duplex kidney in children. Methods Retrospective analysis of 53 cases undergone partial nephrectomy, performed in 32 girls and 21 boys with the mean age of (35.8±36.8) months from March 2013 to September 2015. The patients were divided into 2 different groups by odd and even outpatient service numbers. Group A: conventional open surgery of partial nepherectomy(n=29); Group B: transumbilical laparoendoscopic single-site Heminephroureterectomy (n=24). In group A, there were 12 boys and 17 girls, 12 of ureterocele, 7 of vesieoureteral reflux (VUR), 9 cases were of ectopie ureter and 8 of urinary tract infection (UTI), mean age was (46.0±38.3)months. In group B, there were 9 boys and 15 girls, 10 of ureterocele, 4 of VUR, 5 cases were of ectopie ureter and 7 of UTI, mean age was(20.2±28.6)months. There was no statistically significant difference in age, gender composition, affected side. Results 53 operations were done successful. There was 1 case conversion to open surgery and 2 cases added an additional port besides the umbilicus in Group B, and all occurred in the early stage of the study. Compared Group A with Group B, the operation time[(137.0±28.8) min vs.(167.3±43.7) min, P=0.006]; blood loss[(45.7±28.8) ml vs.(23.2±43.7) ml, P=0.134]; blood transfusion (6 vs.4, P=0.709); time of resumption to a regular diet[(1.4±1.5) d vs.(1.4±1.1) d, P=0.785]; time of indwelling drainage tube [(5.1±1.6) d vs.(4.1±2.0) d, P=0.200]; postoperative hospital stay [(8.6±2.0) d vs.(8.6±2.0) d, P=0.725]. The mean time of follow up after surgery is 18.2 months (2-31 months). Complications after surgery between group A and B included hypertension (2 vs. 0, P=0.495); urinary tract infection (2 vs.3, P=0.824), distal ureteric stump(DVS) (0 vs.1, P=0.453) and renal functional loss (1 vs.0, P=1.000). Conclusion The transumbilical laparoendoscopic single-site heminephrectomy is safe, feasible, effective in experienced pediatric urologic surgeons and high volume centres. It can reach or even exceed the effect of traditional open surgery. After the learning period, the operation time was significantly shortened, and can reach or be lower than open surgery time. Transumbilical laparoendoscopic single-site surgery (LESS) has the advantages of reduce the surgical trauma and better cosmetic results. Key words: Laparoendoscopic; Duplex kidney; Heminephroureterectomy; Laparoendoscopic single-site surgery