Laparoscopic complete/partial nephroureterectomy in children in a single institution—nearly a decade of experience: what have we learned?

Abstract

To review our experience of laparoscopic nephroureterectomy and hemi-nephroureterectomy over a 10-year period. Forty patients had surgery between December 2000 and April 2010. Case notes were reviewed for clinical data, intraoperative time, complications, postoperative management, outcome and follow-up. Mean age was 5.2 years. Thirty patients underwent nephroureterectomy. There were complications in five. Four required conversion. Two had bleeding from an adherent upper pole. One had adhesions from previous pyeloplasty. The fourth had a staghorn calculus secondary to xanthogranulomatous pyelonephritis. There were extensive inflammatory adhesions and despite early conversion, operating time was 9 h. Excluding this, mean operating time was 159 min. Nine patients underwent hemi-nephroureterectomy. There were complications in two; a hilar bleed and a peritoneal tear (neither required conversion). Mean operating time was 177 min. One patient with MCDK was for nephroureterectomy, but no renal tissue was found at laparoscopy and the procedure was abandoned. Laparoscopic nephroureterectomy/hemi-nephroureterectomy is well tolerated in children and should be the preferred option. Operative time is acceptable. There are few complications. Patients with MCDK should have an ultrasound before surgery to confirm ongoing presence of renal tissue. In patients with xanthogranulomatous disease, laparoscopy should be avoided.