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Huang L, Peng S. Comparison of enhanced recovery after surgery vs. conventional protocol during perioperative care in laparoscopic nephrectomy for benign non-functioning kidney. Minerva Med 2021; 113:356-358. [PMID: 34114444 DOI: 10.23736/s0026-4806.21.07590-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Li Huang
- Department of Urology, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Shuang Peng
- Clinical Nursing Teaching and Research Section, The Second Xiangya Hospital, Central South University, Changsha, China -
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Aydogdu I, Silay MS. Transperitoneal laparoscopic heminephroureterectomy in pediatric population: A single-centre experience using a sealing device. Can Urol Assoc J 2018; 12:E409-E414. [PMID: 29787375 DOI: 10.5489/cuaj.4992] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
INTRODUCTION We sought to report the outcomes of transperitoneal laparoscopic heminephroureterectomy (LHNU) in pediatric population and to describe the technical details of this minimally invasive surgery. METHODS Seventeen pediatric patients (18 renal units), who had consecutive transperitoneal LHNU in our department between January 2012 and July 2017 were included in the study. In all patients, diagnostic cystoscopy and retrograde pyelography were carried out immediately before the operation. A catheter was inserted in the unaffected ureter and fixed. LHNU with a transperitoneal approach was carried out in all patients with the aid of LigaSure®. After removal of the specimen, the intervention was finalized with the insertion of a drain. All intraoperative and postoperative data of the patients were recorded prospectively. RESULTS The average age of the patients was 55.9±35.8 months (range 8-121). The average duration of the operations was 121.7±24.0 minutes (range 100-200). The average hospitalization time was 1.6±0.4 days (range 1-2). No intraoperative complication occurred in our patients. The average followup period was 29.1±13.4 months (range 4-48). During the followup period, no complications were observed except one patient who had pyelonephritis within the first month of surgery. CONCLUSIONS Transperitoneal LHNU is a minimally invasive method that can be used safely in pediatric patients. Using a standardized technique during the procedure is critical to increase the success and decrease the complication rates.
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Affiliation(s)
- Ibrahim Aydogdu
- Bezmialem Vakif University, Faculty of Medicine, Department of Pediatric Surgery
| | - Mesrur Selcuk Silay
- Istanbul Medeniyet University, Faculty of Medicine, Department of Pediatric Urology; Istanbul, Turkey
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Mei H, Qi T, Li S, Pu J, Cao G, Tang S, Zheng L, Tong Q. Transumbilical multiport laparoscopic nephroureterectomy for congenital renal dysplasia in children: midterm follow-up from a single institution. Front Pediatr 2013; 1:46. [PMID: 24400291 PMCID: PMC3864248 DOI: 10.3389/fped.2013.00046] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2013] [Accepted: 12/02/2013] [Indexed: 01/27/2023] Open
Abstract
OBJECTIVE To assess the clinical utility and efficiency of transumbilical multiport laparoscopic nephroureterectomy (TMLN) for the treatment of congenital renal dysplasia in children by analyzing consecutive cases from a single institution. METHODS Sixteen children underwent TMLN procedure due to dysplastic kidney between January 2010 and December 2011. The surgery was transperitoneally performed through three transumbilical incisions for two 5-mm and one 3-mm ports, which duplicated the standard laparoscopic steps with the usual laparoscopic instruments. Demographic, perioperative, and follow-up data were analyzed. RESULTS TMLN was performed in all patients, without additional ports or conversion to open surgery. The mean operation time was 108.4 min (range 90-125), and the blood loss was minimal. There were no severe intraoperative or post-operative complications. The post-operative recovery was uneventful in all patients. No urinary incontinence or umbilical hernias occurred. The cosmetic result was excellent as the incision scar was hidden inside the belly button. CONCLUSION TMLN is a safe and efficient procedure for the management of congenital renal dysplasia in children with good cosmesis. Future randomized studies with a larger number of cases and a longer follow-up are warranted to elucidate the benefits and limitations of TMLN in children.
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Affiliation(s)
- Hong Mei
- Department of Pediatric Surgery, Union Hospital of Tongji Medical College, Huazhong University of Science and Technology , Wuhan, Hubei Province , China
| | - Teng Qi
- Department of Pediatric Surgery, Union Hospital of Tongji Medical College, Huazhong University of Science and Technology , Wuhan, Hubei Province , China
| | - Shuai Li
- Department of Pediatric Surgery, Union Hospital of Tongji Medical College, Huazhong University of Science and Technology , Wuhan, Hubei Province , China
| | - Jiarui Pu
- Department of Pediatric Surgery, Union Hospital of Tongji Medical College, Huazhong University of Science and Technology , Wuhan, Hubei Province , China
| | - Guoqing Cao
- Department of Pediatric Surgery, Union Hospital of Tongji Medical College, Huazhong University of Science and Technology , Wuhan, Hubei Province , China
| | - Shaotao Tang
- Department of Pediatric Surgery, Union Hospital of Tongji Medical College, Huazhong University of Science and Technology , Wuhan, Hubei Province , China
| | - Liduan Zheng
- Department of Pathology, Union Hospital of Tongji Medical College, Huazhong University of Science and Technology , Wuhan, Hubei Province , China ; Clinical Center of Human Genomic Research, Union Hospital of Tongji Medical College, Huazhong University of Science and Technology , Wuhan, Hubei Province , China
| | - Qiangsong Tong
- Department of Pediatric Surgery, Union Hospital of Tongji Medical College, Huazhong University of Science and Technology , Wuhan, Hubei Province , China ; Clinical Center of Human Genomic Research, Union Hospital of Tongji Medical College, Huazhong University of Science and Technology , Wuhan, Hubei Province , China
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Tomaszewski JJ, Casella DP, Turner RM, Casale P, Ost MC. Pediatric laparoscopic and robot-assisted laparoscopic surgery: technical considerations. J Endourol 2011; 26:602-13. [PMID: 22050504 DOI: 10.1089/end.2011.0252] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Laparoscopy has become an effective modality for the treatment of many pediatric urologic conditions that need both extirpative and reconstructive techniques. Laparoscopic procedures for urologic diseases in children, such as pyeloplasty, orchiopexy, nephrectomy, and bladder augmentation, have proven to be safe and effective with outcomes comparable to those of open techniques. Given the steep learning curve and technical difficulty of laparoscopic surgery, robot-assisted laparoscopic surgery (RAS) is increasingly being adopted in pediatric patients worldwide. Anything that can be performed laparoscopically in adults can be extended into pediatric practice with minor technical refinements. We review the role of laparoscopic and RAS in pediatric urology and provide technical considerations necessary to perform minimally invasive surgery successfully.
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Affiliation(s)
- Jeffrey J Tomaszewski
- Division of Pediatric Urology, Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA.
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Javid PJ, Lendvay TS, Acierno S, Gow KW. Laparoscopic nephroureterectomy for Wilms' tumor: oncologic considerations. J Pediatr Surg 2011; 46:978-82. [PMID: 21616265 DOI: 10.1016/j.jpedsurg.2011.01.014] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2010] [Revised: 12/30/2010] [Accepted: 01/16/2011] [Indexed: 11/16/2022]
Abstract
Wilms' tumor is the most common malignant renal tumor of childhood. Surgical resection is an important aspect of therapy and is traditionally performed through an open transabdominal approach. The advent of advanced laparoscopic techniques for benign renal lesions has led to interest in applying a minimally invasive approach to Wilms' tumors in children. We describe a 2-year-old girl who presented with a right renal mass measuring 18 × 13 cm with peritoneal seeding and pulmonary metastatic disease. Wilms' tumor was confirmed on open biopsy. After neoadjuvant chemotherapy, a laparoscopic resection of the tumor with right radical nephroureterectomy, retroperitoneal lymph node dissection, and resection of peritoneal metastases was achieved using one 12-mm and four 5-mm ports. The specimens were removed in an endoscopic retrieval bag through a small Pfannenstiel incision by extending the 12-mm port site. The patient had an uncomplicated recovery and was discharged on the fifth post-operative day. She remains disease free at 19 months postoperatively. Minimally invasive techniques may be considered for resection of Wilms' tumor provided oncologic principles are carefully followed.
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Affiliation(s)
- Patrick J Javid
- Division of Pediatric General and Thoracic Surgery, Seattle Children's Hospital, Seattle, WA 98105, USA.
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Mattioli G, Pini-Prato A, Costanzo S, Avanzini S, Rossi V, Basile A, Ghiggeri GM, Magnasco A, Leggio S, Rapuzzi G, Jasonni V. Nephrectomy for multicystic dysplastic kidney and renal hypodysplasia in children: where do we stand? Pediatr Surg Int 2010; 26:523-8. [PMID: 20339852 DOI: 10.1007/s00383-010-2592-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/10/2010] [Indexed: 10/19/2022]
Abstract
OBJECTIVES Little is reported in literature regarding correct management of benign lesions of the kidney. The aim of our study is to present a series of total and partial nephrectomies performed in the last 5 years and to discuss indications. MATERIALS AND METHODS Patients with benign lesions who underwent nephrectomy and partial nephrectomy at our institution in the period 2003-2008 were retrospectively included in the study. Notes were carefully reviewed and demographic data, symptoms onset, preoperative diagnosis, investigations, medical and/or surgical treatment, postoperative complications and definitive histological reports were collected. RESULTS Forty procedures were performed. Twelve patients were preoperatively diagnosed of having multicystic dysplastic kidney (MCDK), which was confirmed in 10, whereas the remaining 28 patients of having severe dysplasia or hypodysplasia. Thirty-four patients underwent total nephrectomy, six underwent partial nephrectomy. Histopathological analysis confirmed segmental or complete abnormalities of the involved kidney in all cases. No malignancies were detected. DISCUSSION Our study confirmed the extremely low malignancy rate of MCDK and hypodysplastic kidneys. The 20% mismatch of pre- and post-operative diagnosis suggests a common aetiology and shared therapeutic strategies for MCDK and hypodysplasia. At present, there is no consensus regarding correct indications for nephrectomy in paediatric age. As nephrectomy seems not to provide any advantage over preservation, but surgical and anesthesiological risks, we should be prudent in preserving every asymptomatic poorly or non-functioning kidneys maintaining a strict follow-up. Randomised controlled studies on larger multicentric series are strongly warranted to define this topic.
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Affiliation(s)
- Girolamo Mattioli
- Pediatric Surgery Department, Gaslini Research Institute and Children Hospital, University of Genova, Largo G. Gaslini, 16100, Genoa, Italy
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Lee DJ, Kim PH, Koh CJ. Current trends in pediatric minimally invasive urologic surgery. Korean J Urol 2010; 51:80-7. [PMID: 20414418 PMCID: PMC2855486 DOI: 10.4111/kju.2010.51.2.80] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2010] [Accepted: 02/12/2010] [Indexed: 12/12/2022] Open
Abstract
Over the past two decades, laparoscopic and robotic surgery in children has been described as a viable minimally invasive alternative to open surgery for many pediatric urologic conditions. With the goal of reducing the morbidity associated with open surgery, minimally invasive surgery in children is increasingly being performed as laparoscopic and robotic patients appear to be experiencing shorter hospital stays, decreased pain medication requirements, and the potential for improved cosmesis. This article provides an overview of the existing literature in laparoscopic and robotic-assisted laparoscopic urologic surgery in children. Laparoscopic and robotic-assisted laparoscopic surgery appears to be safe and effective in children for a wide range of ablative and reconstructive procedures. Conventional laparoscopic surgery is effective for ablative procedures, while robotic surgery may be ideally suited for reconstructive cases requiring advanced suturing and dissection. Overall, more prospective studies are needed to study the long-term outcomes of minimally invasive surgery in pediatric patients, and the appropriate use of the available technology.
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Affiliation(s)
- Dennis J Lee
- Department of Pediatric Urology, Childrens Hospital Los Angeles, University of Southern California (USC) Institute of Urology, Keck School of Medicine, USC, Los Angeles, California, USA
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Abstract
The use of laparoscopy has evolved over the last 30 years, particularly in the last decade, from merely extirpative or diagnostic procedures to intricate reconstructive procedures on the major genitourinary organs. The development of laparoscopy as a method of treating urological problems has progressed more slowly in children compared with adults; perhaps due to the availability of miniaturized technology, the steep learning curve and the high success of traditional open surgery. This article seeks to provide a comprehensive review of the evolution of laparoscopy from its inception to its present-day applications in the field of pediatric urology, including the current indications and results of various laparoscopic procedures.
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Affiliation(s)
- Regina D Norris
- Children's Hospital of Pittsburgh, Pediatric Urology, 45th and Penn Avenue, 4th Floor Faculty Pavilion, Pittsburgh, PA 15201, USA
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de Lorca APL, Fraile AG, Bramtot AA, Brabancho DC, Vázquez FL, Fernández JC. [Complications in laparoscopy renal surgery in pediatric age: analysis of our experience and literature review]. Actas Urol Esp 2009; 33:670-80. [PMID: 19711751 DOI: 10.1016/s0210-4806(09)74206-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
INTRODUCTION The development of the minimally invasive surgery in pediatric age has been slower than in the adult age since their advantages are not so clear. The learning curve and the complications presented during this period, as well as the type of material used has been the factors that have contributed to this fact. OBJECTIVE We collected our experience and the complications presented in renal laparoscopic exegesis surgery, adding a review of the published literature to date. MATERIALS AND METHODS Retrospective study of our clinical cases in that we practiced laparoscopic renal exegesis surgery. We collected 56 cases from January 2003, when it was implanted, to September 2008. We had 36 boys (64%) and 20 girls (36%). The mean age was 3.6 years. We analyzed principal diagnosis, the situation that conducted to the surgery and the type of surgery performed, time of surgery, hospital stay and complications with their solution. The results were analyzed the statistical program SPSS (SPSSCorp, Chicago, Illinois). The literature review was practiced in MEDLINE, EMBASE and COCHRANE database. The selected works were reviewed by two investigators. Series containing adults were excluded. RESULTS We perfomed 42 nephrectomies (75%), 13 heminephrectomies (23%) and 1 quistectomy (2%). 5 cases (9%) were done by retroperitoneoscopy and 51 cases (91%) transperitoneally. The mean operative time was 118 +/- 0,75 min, for nephrectomies; 192 +/- 1.07 min, for partial nephrectomies, 111 +/- 0,64 for nephroureterectomies and 240 min for quistectomia. The mean hospital stay was 3.18 min (2-6) days for nephrectomies; 5.91 (3-11) days for partial nephrectomies, 3 days (2-4) for nephroureterectomies and 6 days for the quistectomy. We had 8 complications (14%): 2 conversions for bledding and technical difficulty and 6 postoperative complications (3 were minor complications, postoperative fever and 3 mayor (2 Urinomas and one pseudoaneurism, requiring 2 interventions and one catheter double J placement). The evolution has been satisfactory in all cases. In the bibliographic review 47 articles with a level of evidence IIIB were selected (Oxford Centers for Evidence-based Medicine). The main reasons to conversion to open surgery were vascular problems and the complication rate change from anyone to 37%. CONCLUSIONS Laparoscopic surgery has proved to be a secure and feasible technique in the treatment of benign renal pathology in pediatric age with satisfactory results. Actually the indications are expanding to reconstructive procedures, with promising results, and selected oncologic procedures.
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Yu HT, Chao A, Wang CJ, Chao AS, Lai CY, Wang CR, Huang YC. Integrated imaging studies and endoscopic management of purulent vaginal discharge in a 6-year-old: vaginal ectopic ureter associated with ipsilateral dysplastic kidney. Eur J Obstet Gynecol Reprod Biol 2008; 142:160-1. [PMID: 19036493 DOI: 10.1016/j.ejogrb.2008.10.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2008] [Revised: 09/09/2008] [Accepted: 10/03/2008] [Indexed: 11/24/2022]
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