Abstract
Laparoscopic nephrectomies (LNs) may be performed in children with benign renal disease by the transperitoneal (TP) or retroperitoneal (RP) approach. The aim of this study was to present our early results from using both the laparoscopic transperitoneal and retroperitoneal approach, highlighting the change in the approach to a better, simpler procedure performed by experienced surgeons. Between February 2002 and June 2006, 30 LNs were performed, with the first 10 patients by TP (group 1) and the remaining patients by RP (group 2). Two patients were not included. Demographic data were compared: mean age (88 vs. 66.6 months), gender (30% female vs. 70% male), and laterality (60% left-handed vs. 40% right-handed). Other factors were assessed, as well: Operating time was compared, as was morbidity, analgesics requirement, postoperative hospital stay, and time to resume oral intake. LN was performed in 28 of the 30 cases. One case in each group was converted. Both groups were similar regarding operating time (TP: 92.2 minutes vs. RP: 121.1), hospital stay (36.5 hours vs. 28.8), postoperative analgesia (2.1 doses of dipyrone and 1.2 doses of nalbuphine vs. 2.3 and 1.4). RP was associated with significantly faster postoperative analgesia tolerance than that of the TP approach (7.8 hours vs. 14.4; P < 0.05). Two (22.2%) patients in group 1 presented with vomiting, whereas no patients in group 2 had postoperative vomiting (P < 0.05). No further postoperative complications appeared. In our hands, both laparoscopic TP and RP approaches are equally safe and effective, but the operating time was slightly shorter (not significant) and postoperative recovery significantly longer for TP. LN may be performed by both approaches, obtaining equal efficacy. TP may be associated with minimal paralytic ileus within the first 12-24 hours, meanwhile RP is related with better surgical skill and postoperative tolerance.
Highlights
Over the past decade, nothing has changed the practice of pediatric urology as much as the expansion in the minimally invasive techniques for routine operations
Shibata and Nagata (Shibata et al, 2001) report that nephron induction with filtrating function occurs before the development of cysts; early fetal urinary tract obstruction causes cystic formation in the developing nephrons, which subsequently disrupts nephron induction and tubular development and cited the importance of abnormalities in the activity of transcription factor PAX2 and antiapoptosis protein bcl2 in the pathogenesis of renal dysplasia
Defects in terminal maturation are observed in polycystic kidney disease
Summary
Over the past decade, nothing has changed the practice of pediatric urology as much as the expansion in the minimally invasive techniques for routine operations. The total nephrectomy with or without ureterectomy, might be indicated for multicystic dysplastic kidney, for destructed kidney by obstructive uropathy and for small kidney with hypertension. Shibata and Nagata (Shibata et al, 2001) report that nephron induction with filtrating function occurs before the development of cysts; early fetal urinary tract obstruction causes cystic formation in the developing nephrons, which subsequently disrupts nephron induction and tubular development and cited the importance of abnormalities in the activity of transcription factor PAX2 and antiapoptosis protein bcl in the pathogenesis of renal dysplasia. The aberrant early development group, include dysplastic kidneys, whether large multicystic dysplastic kidneys or small organs with combination of hypoplasia– dysplasia and some obstructed kidneys. Defects in terminal maturation are observed in polycystic kidney disease This category of renal disease is usually not associated with an obstructive uropathy and is mainly managed by nephrologists for the development of renal failure and hypertension. Dysplastic kidneys can be any size, ranging between massive kidney with multiple large cyst up to 9 cm, to normal or small kidneys with or without cyst. (figure 2) Dysplasia can be unilateral, bilateral, or segmental affecting only part of the kidney
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