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Abstract
PURPOSE To analyze the role of laparoscopic surgery for the management of pediatric adrenal tumors (AT). METHODS Retrospective analysis of children diagnosed with AT, operated laparoscopically during 2003-2020. The strategy differed according to tumor extension. AT < 6 cm were resected. Locally advanced tumors (L2) or > 6 cm were biopsied. RESULTS N = 28. Complete tumor resection (R0) in 20 (71%), tumor biopsy in 8 (R2). Age (median): 28.8 months (2 months-18 years). 14/28 left-sided, 2 bilateral. Median operating time: 78 min (45-180). Mean tumor size (for resections): 4 cm (2.5-6). Tumor pathology: neuroblastoma (n = 17), Ganglioneuroma (n = 7), Adrenocortical carcinoma (n = 1), Osteosarcoma metastasis (n = 1), Pheochromocytoma (n = 1), Venous malformation (n = 1). Mean hospital stay: 2.5 days (1-3). Mean follow up: 65.5 months (24-192). Overall survival and event-free survival were 86 and 75%, respectively (5 years event-free survival for neuroblastoma: 33% [intermediate risk], 16.6% [high risk]. No surgery-related mortality. CONCLUSION Laparoscopic surgery for adrenal tumors is safe. Laparoscopic biopsy is useful for unresectable tumors when a percutaneous approach is not possible. With the proposed selection criteria, the laparoscopic approach should be the first option for resection of small and localized AT in pediatrics.
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Sosnowska-Sienkiewicz P, Strauss E, Bućko E, Dopierała M, Mańkowski P, Januszkiewicz-Lewandowska D. Are There Any Limiting Factors of Minimally Invasive Adrenalectomy in Children? Over 20-Year Single-Center Experience. POLISH JOURNAL OF SURGERY 2022; 94:46-53. [DOI: 10.5604/01.3001.0015.7783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
<b> Introduction:</b> Laparoscopic adrenalectomy is more widely recognized as a valuable treatment method for benign and malignant tumours. </br></br> <b>Aim:</b> This study reviews over 20-year experience with laparoscopic adrenalectomy in children in Central-West Poland. </br></br> <b>Materials and methods:</b> During the last 21 years, 5041 laparoscopic procedures were performed, among them 39 adrenalectomies in children aged from 2 days to 17 years. The following data were analysed: patient's age at diagnosis and surgery, lesion volume in CT/MRI examination, duration of surgery, the incidence of complication after surgery, and length of hospitalization. </br></br> <b>Results:</b> The volume of adrenal lesion visualized by CT or MRI before surgery varied from 0.5 cm3 up to 490 cm3, with a median of 14 cm3. As many as 80% of adrenalectomies allowed radical removal of the lesion and 92% of those procedures were performed without any complications. From all data analysed, only age, both at diagnosis and at surgery, was significantly lower in patients with a malignant lesion. </br></br> <b>Conclusions:</b> Laparoscopic adrenalectomy is a valuable method to use in paediatric patients for both benign and malignant adrenal lesions. However, in patients with malignant adrenal lesions it may be expected that the procedure will be more difficult due to the lower age and larger lesion size.
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Affiliation(s)
| | - Ewa Strauss
- Institute of Human Genetics, Polish Academy of Sciences, Poznan, Poland
| | - Ewa Bućko
- Karol Jonscher Hospital, Poznan, Poland
| | - Maria Dopierała
- Student Scientific Group of Pediatric Surgery, Poznan University of Medical Sciences, Poland
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Blanc T, Meignan P, Vinit N, Ballouhey Q, Pio L, Capito C, Harte C, Vatta F, Galmiche-Rolland L, Minard V, Orbach D, Berteloot L, Muller C, Kohaut J, Broch A, Braik K, Binet A, Heloury Y, Fourcade L, Lardy H, Sarnacki S. Robotic Surgery in Pediatric Oncology: Lessons Learned from the First 100 Tumors-A Nationwide Experience. Ann Surg Oncol 2021; 29:1315-1326. [PMID: 34523002 DOI: 10.1245/s10434-021-10777-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 08/21/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND While robotics has become commonplace in adult oncology, it remains rare in pediatric oncology due to the rarity of childhood cancers. We present the results of a large nationwide experience with robotic oncology, with the aim of providing practical and feasible guidelines for child selection. METHODS This was a prospective analysis performed over a period of 4 years. Treatment was delivered according to the Société Internationale d'Oncologie Pédiatrique/International Society of Paediatric Oncology Europe Neuroblastoma Group (SIOP/SIOPEN) protocols. Indications were approved by a certified tumor board. RESULTS Overall, 100 tumors were resected during 93 procedures (abdomen, 67%; thorax, 17%; pelvis, 10%; retroperitoneum, 6%) in 89 children (56 girls). The median age at surgery was 8.2 years (range 3.6-13); 19 children (21%) harbored germinal genetic alterations predisposing to cancer. No intraoperative tumor ruptures occurred. Seven conversions (8%) to an open approach were performed. Neuroblastic tumors (n = 31) comprised the main group (18 neuroblastomas, 4 ganglioneuroblastomas, 9 ganglioneuromas) and renal tumors comprised the second largest group (n = 24, including 20 Wilms' tumors). The remaining 45 tumors included neuroendocrine (n = 12), adrenal (n = 9), germ-cell (n = 7), pancreatic (n = 4), thymic (n = 4), inflammatory myofibroblastic (n = 4), and different rare tumors (n = 5). Overall, 51 tumors were malignant, 2 were borderline, and 47 were benign. The median hospital stay was 3 days (2-4), and five postoperative complications occurred within the first 30 days. During a median follow-up of 2.4 years, one child (Wilms' tumor) presented with pleural recurrence. One girl with Wilms' tumor died of central nervous system metastasis. CONCLUSIONS Robotic surgery for pediatric tumors is a safe option in highly selected cases. Indications should be discussed by tumor boards to avoid widespread and uncontrolled application.
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Affiliation(s)
- Thomas Blanc
- Department of Pediatric Surgery and Urology, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France. .,Université de Paris, Paris, France. .,Département « Croissance et Signalisation », Centre National de la Recherche Scientifique UMR8253, Institut National de la Santé et de la Recherche Médicale U1151, Institut Necker Enfants Malades, Université de Paris, Paris, France.
| | - Pierre Meignan
- Department of Pediatric Surgery and Urology, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France.,Department of Pediatric Surgery, Hôpital Clocheville, Tours, France
| | - Nicolas Vinit
- Department of Pediatric Surgery and Urology, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Quentin Ballouhey
- Department of Pediatric Surgery, Hôpital des Enfants, Limoges, France
| | - Luca Pio
- Department of Pediatric Surgery and Urology, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Carmen Capito
- Department of Pediatric Surgery and Urology, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Caroline Harte
- Department of Pediatric Anesthesia, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Fabrizio Vatta
- Department of Pediatric Surgery and Urology, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Louise Galmiche-Rolland
- Department of Pathology, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Véronique Minard
- Department of Pediatric and Adolescent Oncology, Institut Gustave Roussy, Villejuif, France
| | - Daniel Orbach
- Department of Pediatric Oncology SIREDO Oncology Center (Care, Innovation and Research for Children and AYA with Cancer), Institut Curie, PSL Research University, Paris, France
| | - Laureline Berteloot
- Department of Pediatric Radiology, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Cécile Muller
- Department of Pediatric Surgery and Urology, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Jules Kohaut
- Department of Pediatric Surgery and Urology, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Aline Broch
- Department of Pediatric Surgery and Urology, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Karim Braik
- Department of Pediatric Surgery, Hôpital Clocheville, Tours, France
| | - Aurélien Binet
- Department of Pediatric Surgery, Hôpital Clocheville, Tours, France
| | - Yves Heloury
- Department of Pediatric Surgery and Urology, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France.,Université de Paris, Paris, France
| | - Laurent Fourcade
- Department of Pediatric Surgery, Hôpital des Enfants, Limoges, France
| | - Hubert Lardy
- Department of Pediatric Surgery, Hôpital Clocheville, Tours, France
| | - Sabine Sarnacki
- Department of Pediatric Surgery and Urology, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France.,Université de Paris, Paris, France
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Surgical Approaches to Neuroblastoma: Review of the Operative Techniques. CHILDREN-BASEL 2021; 8:children8060446. [PMID: 34070327 PMCID: PMC8227756 DOI: 10.3390/children8060446] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 05/07/2021] [Accepted: 05/20/2021] [Indexed: 11/17/2022]
Abstract
Neuroblastoma (NB) is the most commonly occurring soft-tissue malignancy of childhood. Surgery plays an important role in multidisciplinary treatment and its principal aim is a local control of the disease, respecting the integrity of the surrounding structures. There is no unanimous consensus on the best surgical technique, and the operative approach largely depends on the anatomical location and the extension of the mass. To have a complete overview of the different type of treatment, we made a review of the literature from the last twenty years of all the surgical approaches applied for NBs resection, accordingly to the anatomical site.
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Dokumcu Z, Divarci E, Ertan Y, Celik A. Laparoscopic adrenalectomy in children: A 25-case series and review of the literature. J Pediatr Surg 2018; 53:1800-1805. [PMID: 29254846 DOI: 10.1016/j.jpedsurg.2017.11.055] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Revised: 11/13/2017] [Accepted: 11/21/2017] [Indexed: 11/18/2022]
Abstract
BACKGROUND Laparoscopic adrenalectomy (LA) is the gold standard and is widely performed in adults, but its use in children is relatively new. We aim to present our experience in twenty-five children with diverse adrenal pathologies and to discuss an extensive review of pediatric LA in English literature. METHODS Medical records of children with adrenal tumors admitted to a tertiary center and treated with LA were reviewed. Characteristics and outcome of patients were compared with results of a systematic Pubmed/Medline literature review. RESULTS Transperitoneal LAs were performed for 12 malignant and 14 benign adrenal masses (size range: 2-8cm) in 25 children (median age:63months). Fourteen lesions were on the right side, and there was one bilateral case. There were no conversion and no complication within 36months of follow-up. A literature review revealed 437 pediatric LAs with left side predomination (51.4%). The indication was a malignant lesion in 60.2% of the cases (sizes range: 1-10cm). The transperitoneal route was preferred in 94.2% of the procedures. Conversion and complication rates were 7.5% and 3.1%, respectively. CONCLUSION LA should be preferred in selected children with adrenal pathologies. The transperitoneal route seems to be the standard approach for pediatric surgeons. Preoperative planning and surgical expertise are the keys to success. TYPE OF THE STUDY Case series with systematic literature review. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Zafer Dokumcu
- Ege University Faculty of Medicine, Department of Pediatric Surgery, Izmir, Turkey.
| | - Emre Divarci
- Ege University Faculty of Medicine, Department of Pediatric Surgery, Izmir, Turkey.
| | - Yesim Ertan
- Ege University Faculty of Medicine, Department of Pathology, Izmir, Turkey.
| | - Ahmet Celik
- Ege University Faculty of Medicine, Department of Pediatric Surgery, Izmir, Turkey.
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Oh C, Youn JK, Han JW, Kim HY, Jung SE. Abdominal tumors in children: Comparison between minimally invasive surgery and traditional open surgery. Medicine (Baltimore) 2016; 95:e5181. [PMID: 27861341 PMCID: PMC5120898 DOI: 10.1097/md.0000000000005181] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The use of minimally invasive surgery (MIS) in pediatric patients has been steadily increasing in recent years. However, its use for diagnosing and treating abdominal tumors in children is still limited compared with adults, especially when malignancy is a matter of debate. Here, we describe the experience at our center with pediatric abdominal tumors to show the safety and feasibility of MIS.Based on a retrospective review of patient records, we selected for study those pediatric patients who had undergone diagnostic exploration or curative resection for abdominal tumors at a single center from January 2010 through August 2015.Diagnostic exploration for abdominal tumors was performed in 32 cases and curative resection in 173 cases (205 operations). MIS was performed in 11 cases of diagnostic exploration (34.4%) and 38 cases of curative resection (21.9%). The mean age of the children who underwent MIS was 6.09 ± 5.2 years. With regard to diagnostic exploration, patient characteristics and surgical outcomes were found to be similar for MIS and open surgery. With regard to curative resection, however, the mean age was significantly lower among the patients who underwent open surgery (4.21 ± 4.20 vs 6.02 ± 4.99 for MIS, P = 0.047), and the proportion of malignancies was significantly higher (80% vs 39.4% for MIS, P < 0.001). MIS compared favorably with open surgery with respect to the rate of recurrence (6.7% vs 35.1%, P = 0.035), the rate of intraoperative transfusions (34.2% vs 58.5%, P = 0.01), the median amount of blood transfused (14 vs 22 mL/kg, P = 0.001), and the mean number of hospital days (4.66 ± 2.36 vs 7.21 ± 5.09, P < 0.001). Complication rates did not differ significantly between the MIS and open surgery groups. The operation was converted to open surgery in 3 cases (27.2%) of diagnostic MIS and in 5 cases (13.1%) of curative MIS.MIS was found to be both feasible and effective for the diagnosis and curative treatment of pediatric abdominal tumors. However, to determine the surgical role and guidelines for MIS for each specific tumor, a multicenter prospective study with a long-term follow-up is warranted.
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Antoniou D, Karetsos C. Laparoscopy or retroperitoneoscopy: which is the best approach in pediatric urology? Transl Pediatr 2016; 5:205-213. [PMID: 27867841 PMCID: PMC5107381 DOI: 10.21037/tp.2016.10.02] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
The emergence of minimally invasive surgery about 20 years ago revolutionized pediatric urology. Advances in pediatric devices allowed the widespread use of minimally invasive techniques in almost the entire range of pediatric urology. In this context, laparoscopy and later retroperitoneoscopy were developed and applied in a wide spectrum of urological diseases. Both approaches have since presented benefits and disadvantages that have been documented in various series. However, few comparative studies have been conducted. The aim of this review is to compare the two approaches and establish which is preferable in each field of pediatric urology.
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Affiliation(s)
- Dimitrios Antoniou
- Sulaiman Al Habib Hospital - Al Takhassusi, Takhassusi Road, 11393 Riyadh, KSA
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8
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Malkan AD, Loh AHP, Sandoval JA. Minimally invasive surgery in the management of abdominal tumors in children. J Pediatr Surg 2014; 49:1171-6. [PMID: 24952811 DOI: 10.1016/j.jpedsurg.2014.04.010] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2014] [Revised: 04/03/2014] [Accepted: 04/16/2014] [Indexed: 11/26/2022]
Abstract
The application of minimally invasive surgical techniques to pediatric abdominal tumors is a controversial application towards the surgical management of childhood cancer. Although general pediatric surgeons practice minimally invasive surgery techniques in a vast array of abdominal cases, its role in pediatric oncology is still developing, with no consensus in North America about its use for pediatric solid abdominal tumors. The purposes of this article are to review the current literature about the use of minimally invasive surgery in pediatric abdominal oncology and to examine established indications, procedures and technologic advances.
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Affiliation(s)
- Alpin D Malkan
- Department of Surgery, St. Jude Children's Research Hospital, Memphis, TN
| | - Amos H P Loh
- Department of Surgery, St. Jude Children's Research Hospital, Memphis, TN
| | - John A Sandoval
- Department of Surgery, St. Jude Children's Research Hospital, Memphis, TN.
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9
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Mattioli G, Avanzini S, Pini Prato A, Pio L, Granata C, Garaventa A, Conte M, Manzitti C, Montobbio G, Buffa P. Laparoscopic resection of adrenal neuroblastoma without image-defined risk factors: a prospective study on 21 consecutive pediatric patients. Pediatr Surg Int 2014; 30:387-94. [PMID: 24477777 DOI: 10.1007/s00383-014-3476-z] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/13/2014] [Indexed: 11/24/2022]
Abstract
BACKGROUND Over the last 20 years MIS has progressively gained popularity in children with cancer. We therefore aimed at evaluating the safety of Minimally Invasive Surgery (MIS) resection in a series of children affected by adrenal neuroblastoma (NB) presenting without Image-Defined Risk Factors (IDRFs). METHODS An Institutional protocol for MIS resection of adrenal NB in pediatric patients without IDRFs has been applied since 2008. Absence of IDRFs represented the main indication for MIS in NB, regardless of tumor size. All pediatric patients who underwent MIS for NB between January 2008 and May 2013 were included. Specific technical considerations, demographic data, and outcome have been recorded. RESULTS Twenty-one patients underwent MIS resection for IDRFs-negative adrenal NB. Nine of these patients experienced preoperative downgrading of IDRFs after chemotherapy. Radiological median diameter of the mass was 30 mm (range 10-83 mm). Median operative time was 90 min. Median hospital stay was 4 days. All patients were treated successfully, without serious intraoperative complications. One mild intraoperative hemorrhage occurred and was treated without the need for conversion to open surgery nor blood transfusion was required. No postoperative complications, including port-site or peritoneal metastases were experienced. CONCLUSIONS This study demonstrated the safety and effectiveness of MIS for the resection of adrenal NB without IDRFs in children. Pediatric surgeons dedicated to oncology should be aware of this alternative approach to open resection.
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Affiliation(s)
- Girolamo Mattioli
- Pediatric Surgery Department, G. Gaslini Children's Hospital and DINOGMI University of Genoa, Largo G. Gaslini 5, 16147, Genoa, Italy,
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Duarte RJ, Dénes FT, Cristofani LM, Srougi M. Laparoscopic nephrectomy for Wilms’ tumor. Expert Rev Anticancer Ther 2014; 9:753-61. [DOI: 10.1586/era.09.44] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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Fallon SC, Feig D, Lopez ME, Brandt ML. The utility of cortical-sparing adrenalectomy in pheochromocytomas associated with genetic syndromes. J Pediatr Surg 2013; 48:1422-5. [PMID: 23845641 DOI: 10.1016/j.jpedsurg.2013.04.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2012] [Revised: 04/02/2013] [Accepted: 04/03/2013] [Indexed: 01/08/2023]
Abstract
Management of pediatric patients with pheochromocytomas associated with genetic syndromes, such as Von Hippel-Lindau (VHL) disease, is complex owing to the need for continuous surveillance, high rates of recurrence, multiple operations during childhood, and the possibility of lifelong exogenous steroid replacement. We report the successful treatment of two siblings with VHL who underwent a total of six cortical-sparing procedures without requiring steroid therapy.
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Affiliation(s)
- Sara C Fallon
- Division of Pediatric Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA
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Blanc T, Muller C, Abdoul H, Peev S, Paye-Jaouen A, Peycelon M, Carricaburu E, El-Ghoneimi A. Retroperitoneal Laparoscopic Pyeloplasty in Children: Long-Term Outcome and Critical Analysis of 10-Year Experience in a Teaching Center. Eur Urol 2013; 63:565-72. [DOI: 10.1016/j.eururo.2012.07.051] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2012] [Accepted: 07/30/2012] [Indexed: 10/28/2022]
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Heloury Y, Muthucumaru M, Panabokke G, Cheng W, Kimber C, Leclair MD. Minimally invasive adrenalectomy in children. J Pediatr Surg 2012; 47:415-21. [PMID: 22325405 DOI: 10.1016/j.jpedsurg.2011.08.003] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2011] [Revised: 07/14/2011] [Accepted: 08/09/2011] [Indexed: 11/24/2022]
Abstract
PURPOSE Minimally invasive adrenalectomy (MIA) is the criterion standard for removal of small adrenal tumors in adults. The purpose of this review was to determine the place of MIA in children. METHODS The authors conducted a systematic review of the pediatric and adult literature about MIA, focusing on the technique and indications. RESULTS Minimally invasive adrenalectomy appears superior to open adrenalectomy for small tumors. The potential advantages of MIA are appealing for postoperative pain, risk of intestinal obstruction, and quality of scars. The most common approach is the transperitoneal lateral laparoscopy, which allows for a large working space. For small tumors or for bilateral adrenalectomy, the prone retroperitoneoscopy is a promising new technique. In children, the learning curve is an issue because the indications are rare. The most common indication is neuroblastoma without image-defined surgical risk factors. The incidence of local recurrence is low, but the follow-up is short in most cases. CONCLUSIONS Minimally invasive adrenalectomy is promising for removal of small adrenal tumors. Long-term follow-up is required to evaluate the efficacy of MIA in neuroblastomas. Benign diseases are excellent candidates for this minimally invasive technique.
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Affiliation(s)
- Yves Heloury
- Department of Pediatric Surgery, Monash Children's, Monash Medical Center, Clayton, Victoria,3168, Australia.
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Eassa W, El-Sherbiny M, Jednak R, Capolicchio JP. The anterior approach to retroperitoneoscopic adrenalectomy in children: technique. J Pediatr Urol 2012; 8:35-9. [PMID: 21236733 DOI: 10.1016/j.jpurol.2010.12.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2010] [Accepted: 12/02/2010] [Indexed: 11/26/2022]
Abstract
PURPOSE Very limited literature exists on minimally invasive adrenalectomy in children. Retroperitoneoscopic adrenalectomy (RPA) has the advantage of avoiding intra-abdominal organ retraction, but concerns have been expressed regarding RPA on the right side. Herein, we describe the second reported experience with the anterior approach to RPA in children, which appears to overcome the limitations previously ascribed to right RPA. MATERIALS AND METHODS Two children, aged 8 and 14-years, presented with incidental right adrenal masses. Both patients were placed in the lateral decubitus position with lumbar hyper-extension. A 5-mm, 3-port approach was used, as demonstrated in the video. RESULTS Pathology revealed a 7-cm ganglioneuroma and a 5-cm pheochromocytoma with intact surgical margins. Operative time with these large masses and first experience with this technique was 5 h in the first case and 3.5 h in the second. No intraoperative or postoperative complications were noted, with minimal blood loss and a hospital stay of 36 h in both cases. CONCLUSION The anterior approach to RPA is feasible even in children with a smaller retroperitoneal space and a large adrenal mass. It provides excellent exposure of the adrenal gland and vein, even on the right side.
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Affiliation(s)
- Waleed Eassa
- Division of Urology, Montreal Children's Hospital, McGill University Health Center, Montreal, QC, Canada
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Sukumar S, Jadhav S, Nair B, Bhat SH, Kumar GP, Mathew G. Laparoscopic adrenal surgery in children: Lessons from a single centre experience. J Minim Access Surg 2011; 7:141-4. [PMID: 21523237 PMCID: PMC3078477 DOI: 10.4103/0972-9941.78346] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2010] [Accepted: 01/05/2011] [Indexed: 01/21/2023] Open
Abstract
PURPOSE: Although commonly performed in adults, laparoscopic adrenalectomy in children is performed only in centres with advanced laparoscopic expertise. MATERIALS AND METHODS: This is a retrospective analysis of laparoscopic adrenalectomies performed at a single centre between January 2003 and May 2010. After preoperative evaluation with biochemical assays and radiologic imaging, surgery was performed by using the lateral transabdominal approach in all patients. RESULTS: Ten laparoscopic adrenalectomies (including three bilateral) were performed in seven children, with a mean age of 9.6 years. The tumours ranged from 2 – 7 cms in size. The operative durations were 75 – 130 minutes (unilateral) and 250 – 270 minutes (bilateral). Operative blood loss was minimal. There were no open conversions, but terminal hand assistance was required in one large right pheochromocytoma. The postoperative hospital stay ranged from 3 – 10 days. The final pathological diagnoses included pheochromocytoma, hyperplasia and neuroblastoma. Follow-up at 24 – 87 months was uneventful. CONCLUSION: With adequate experience in laparoscopy, it is possible to perform adrenalectomy in selected children.
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Affiliation(s)
- Sudhir Sukumar
- Department of Urology, Amrita Institute of Medical Sciences and Research Centre, Kochi, India
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Nerli RB, Reddy MN, Guntaka A, Patil S, Hiremath M. Laparoscopic adrenalectomy for adrenal masses in children. J Pediatr Urol 2011; 7:182-6. [PMID: 20483666 DOI: 10.1016/j.jpurol.2010.04.006] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2009] [Accepted: 04/07/2010] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The laparoscopic approach to the adrenal gland was first reported in 1992. Since then numerous studies have been published, comprising of adults. Experience with the laparoscopic technique for adrenal disease in children and adolescents has been limited. We have reviewed our experience with laparoscopic adrenal surgery in children. PATIENTS AND METHODS All children with pathologic adrenal masses undergoing laparoscopic adrenal surgery were included. The primary study outcome measures included operative time, conversion to open surgery, complications, duration of hospital stay and outcome of surgery. RESULTS Eighteen children underwent laparoscopic adrenalectomy during the period January 2003-July 2009. The mean operating time was 95 min, mean blood loss was 30 ml and the average postoperative hospital stay was 50h. There were no conversions to open surgery and no major intra- or postoperative complications noted. CONCLUSIONS Laparoscopic adrenalectomy is a safe and feasible procedure with good results. It can be used to safely treat suspected benign and malignant adrenal masses in children with minimal morbidity and a shorter hospital stay.
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Affiliation(s)
- Rajendra B Nerli
- Department of Urology, KLES Kidney Foundation, KLE University's JN Medical College, Belgaum 590010, Karnataka, India.
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IPEG guidelines for the surgical treatment of adrenal masses in children. J Laparoendosc Adv Surg Tech A 2010; 20:vii-ix. [PMID: 20230240 DOI: 10.1089/lap.2010.9999] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Laparoscopic adrenalectomy and adrenal biopsy are technically feasible in children. There are no absolute contraindications to the laparoscopic approach, but for neuroblastomas and other adrenal neoplasms, care must be taken to maintain the principles of cancer surgery. As opposed to adults, there are fewer benign indications for adrenalectomy, but in selected cases, laparoscopic resection of the adrenal is feasible. Both laparoscopic and retroperitoneoscopic approaches are recommended, with the choice being dictated by the experience of the surgeon. Recommendations throughout this guideline are based on class 3 evidence, with a single article demonstrating class 2 evidence, based on a retrospective comparison.
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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: 0.8] [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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Boutros J, Bond M, Beaudry P, Blair GK, Skarsgard ED. Case selection in minimally invasive surgical treatment of neuroblastoma. Pediatr Surg Int 2008; 24:1177-80. [PMID: 18716783 DOI: 10.1007/s00383-008-2240-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/07/2008] [Indexed: 10/21/2022]
Abstract
PURPOSE The experience with minimally invasive surgery (MIS) in the treatment of neuroblastoma (NB) is anecdotal. The purpose of this study was to evaluate a retrospective cohort of NB patients who underwent MIS resection of their primary tumors. METHODS A retrospective study of NB patients who underwent MIS resection of their primary tumors over a 3-year period was undertaken. Study outcomes included complications, completeness of resection, and event-free and overall short-term survival. RESULTS Of a total of 21 children who underwent surgical resection for NB during the period of study, 8 (38%) underwent selected MIS resection. Six of the eight (75%) tumors were adrenal in origin and the remainder were located in the posterior mediastinum. Distribution by International Neuroblastoma Staging System (INSS) stage was: stage 1 (3), stage 2 (2), and stage 4 (3). One stage 4 tumor was N-myc amplified. All stage 4 patients experienced a >50% tumor volume cytoreduction in response to preoperative chemotherapy. All MIS resections were performed without need for blood transfusion, or conversion to open procedure, and there were no perioperative complications. All eight patients were alive and disease-free at a median 18-month follow-up. CONCLUSIONS With appropriate preoperative case selection based on anatomic features, MIS tumor resection in patients with NB can be performed safely and effectively.
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Affiliation(s)
- John Boutros
- Division of Pediatric General Surgery, British Columbia Children's Hospital, Vancouver, Canada
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Al-Shanafey S, Habib Z. Feasibility and Safety of Laparoscopic Adrenalectomy in Children: Special Emphasis on Neoplastic Lesions. J Laparoendosc Adv Surg Tech A 2008; 18:306-9. [DOI: 10.1089/lap.2007.0166] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Saud Al-Shanafey
- Department of Surgery, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia
| | - Zakaria Habib
- Department of Surgery, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia
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Ludwig AD, Feig DI, Brandt ML, Hicks MJ, Fitch ME, Cass DL. Recent advances in the diagnosis and treatment of pheochromocytoma in children. Am J Surg 2007; 194:792-6; discussion 796-7. [DOI: 10.1016/j.amjsurg.2007.08.028] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2007] [Revised: 08/13/2007] [Accepted: 08/13/2007] [Indexed: 01/31/2023]
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Abstract
Neuroblastoma is one of the most common solid tumors, and the biopsy and excision of this tumor are often required as part of a planned multimodal treatment. In 1995, Holcomb and coworkers first reported endosurgical procedures for the diagnosis and treatment of pediatric malignancies; however, the usefulness of laparoscopic procedures for abdominal neuroblastoma is still unclear. Twenty-five laparoscopic biopsies for advanced abdominal neuroblastoma and nine laparoscopic excisions for localized abdominal neuroblastoma performed at Saitama Children's Medical Center were evaluated. The laparoscopic procedures significantly reduce the time to start postoperative feeding as well as the time to start postoperative chemotherapy and the duration of hospital stay. Also, the blood loss of laparoscopic excision of localized neuroblastoma was significantly little compared with that of open excision. Precise indications of laparoscopic procedure for the diagnosis and treatment of abdominal neuroblastoma provide better prognosis and quality of life for infants and children.
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Affiliation(s)
- Tadashi Iwanaka
- Department of Pediatric Surgery, The University of Tokyo Graduate School of Medicine, Tokyo, Japan.
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Leclair MD, de Lagausie P, Becmeur F, Varlet F, Thomas C, Valla JS, Petit T, Philippe-Chomette P, Mure PY, Sarnacki S, Michon J, Heloury Y. Laparoscopic resection of abdominal neuroblastoma. Ann Surg Oncol 2007; 15:117-24. [PMID: 17926102 DOI: 10.1245/s10434-007-9499-0] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2006] [Accepted: 12/19/2006] [Indexed: 11/18/2022]
Abstract
BACKGROUND Since indications for laparoscopic adrenalectomy have progressively expanded to pediatric surgery, preliminary reports have studied the laparoscopic approach for abdominal neuroblastoma (NB). We aimed to report on the indications and the results of laparoscopic resection in a large series of abdominal NBs. METHODS A retrospective multicenter study included 45 children with abdominal NBs (28 localized, 11 stage 4, 6 stage 4s) and laparoscopic resection of their abdominal primary tumor. Primary site of the tumor was the adrenal gland in 41 cases and retroperitoneal space in 4. The median age at surgery was 12 months (1-122); median tumor size was 37 mm (12-70). Resection was performed through transperitoneal laparoscopy (n = 38) or retroperitoneoscopy (n = 7). RESULTS Complete macroscopic resection was achieved in 43 of 45 children (96%). The median duration of pneumoperitoneum was 70 min (30-160), and the length of hospital stay was 3 days (2-9). Four procedures (9%) were converted to open surgery, and tumor rupture occurred in three cases. Of the 28 children with localized disease, there was a 96% overall survival (OS) rate after a median follow-up of 28 months (4-94). There was one local relapse in this subgroup, with subsequent complete remission. For the entire 45-children cohort, four children died and three presented a recurrence resulting in OS, disease-free survival, and event-free survival rates of 84% +/- 8.1, 84% +/- 8.2, and 77% +/- 9.1 respectively. CONCLUSION Laparoscopic resection of abdominal primary allows effective local control of the disease in a wide range of clinical situations of neuroblastoma, with an acceptable morbidity.
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Castillo O, Kerkebe M, Vitagliano G, Arellano L. [Single-stage laparoscopic adrenalectomy and pancreatic cyst exsicion in a patient with von Hippel-Lindau disease]. Actas Urol Esp 2007; 31:292-4. [PMID: 17658161 DOI: 10.1016/s0210-4806(07)73638-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Von Hippel-Lindau disease is a dominant autosomic hereditary condition, characterized by cerebellar hemangioblastomas, retinal animas and visceral cysts and tumors. We report a case of a patient with Von Hippel-Lindau in which we performed a single-stage laparoscopic adrenalectomy for a pheochromocytoma and pancreatic cyst excision. PATIENT AND METHOD A 20 year old male patient with Von Hippel Lindau disease underwent laparoscopic adrenalectomy for a 5 cm left adrenal mass. A 3 cm cystic lesion was found of the tail of the pancreas and was resected completely laparoscopically during the same operative procedure. RESULTS Total operative time was 120 minutes. There were no operative or postoperative complications. Blood loss was < 50 mL and hospital stay was 3 days. The histopathologic result was adrenal pheochromocytoma and pancreatic mucous microcystic cystoadenoma. CONCLUSION Laparoscopy allows surgical approach of patients with simultaneous lesions in several abdominal solid viscera, like Von Hippel Lindau disease. This case represents the first report of one-stage laparoscopic adrenalectomy and pancreatic cyst excision.
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Affiliation(s)
- O Castillo
- Unidad de Endourología y Laparoscopia Urológica Clínica Santa María, Universidad de Chile.
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29
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Abstract
Adrenal tumors in children may be benign or malignant. In addition, both benign and malignant tumors may be hormonally active, leading to hypertension, metabolic crises, and endocrinopathies. These tumors may be found incidentally or secondary to signs and symptoms of the aforementioned disorders. Both a metabolic and a radiographic work-up are required before treatment of an adrenal tumor. The primary therapy for most adrenal lesions is surgical, though some are treated medically or require chemotherapy before excision. Laparoscopy has become the surgical approach of choice in both adult and pediatric patients with localized disease. Open surgical approaches remain necessary in patients with extensive locally invasive or metastatic disease.
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Abstract
The spectrum of laparoscopic surgery in children has developed dramatically; what was initially used as a diagnostic method to identify an impalpable testis is now commonly used for complex reconstructive procedures such as pyeloplasty. Laparoscopic orchidopexy and nephrectomy are well established and are used at many centres. Laparoscopic partial nephrectomy, adrenalectomy and dismembered pyeloplasty series have reported shorter hospital stays and operative times that are comparable with that of open techniques, and/or decreasing with experience. The initial experiences with laparoscopic ureteric re-implantation and laparoscopically assisted bladder reconstructive surgery are reported, with encouraging results for feasibility, hospital stay, and cosmetic outcome.
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Affiliation(s)
- Marc C Smaldone
- Urology, University of Pittsburgh Medical Center, 3471 5th Avenue, Pittsburgh, PA 15213, USA.
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López PJ, Pierro A, Curry JI, Mushtaq I. Retroperitoneoscopic adrenalectomy: an early institutional experience. J Pediatr Urol 2007; 3:96-9. [PMID: 18947710 DOI: 10.1016/j.jpurol.2006.05.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2006] [Accepted: 05/12/2006] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To review our initial experience with the retroperitoneoscopic approach, which is rapidly becoming the procedure of choice for paediatric adrenalectomy. Swift access to the vascular pedicle makes this approach ideal for adrenal surgery where haemodynamic instability is a common feature. METHOD Patients were placed in a fully prone position and the locations of the 12th rib, iliac crest and paravertebral muscles were marked. A 10-mm incision was made lateral to the para-vertebral muscle, halfway between the iliac crest and costal margin. A retroperitoneal working space was created around the kidney using a homemade balloon. A 10-mm Hasson port was then inserted. A 5-mm working port was placed lateral to the tip of the 12th rib and, if necessary, a second was inserted medial to the camera port. Dissection was performed with diathermy and/or Harmonic Scalpeltrade mark and the adrenal vessels were divided between clips. The specimen was retrieved in an endopouch through the 10-mm port. RESULTS Over 16 months, six adrenalectomies were performed in five patients (three boys and two girls); two right, two left and one bilateral. Median age at surgery was 8 years. Presentation was with hypertension (n=2), Cushing's syndrome (n=2) and abdominal pain (n=1). Median operative time was 154 min. A single-instrument port adrenalectomy was performed in three patients. Histopathological diagnosis included adrenal cyst (n=1), cystic phaeochromocytoma (n=1), adrenal cortical tumour (n=2) and central Cushing's disease (n=1). All were completely resected. All patients remain symptom free with a median follow up of 17 months. CONCLUSION These cases represent our initial institutional experience with retroperitoneoscopic adrenalectomy. The senior reporting surgeons have already surmounted the general learning curve for laparoscopy, and this experience has proved vital to expand our repertoire with encouraging early results. This is our technique of choice as it provides a superior view of the adrenal gland and vessels, with good intraoperative haemodynamic stability.
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Affiliation(s)
- Pedro-José López
- Department of Paediatric Urology, Great Ormond Street Hospital for Children, Great Ormond Street, London WC1N 3JH, UK
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Sweeney DD, Smaldone MC, Docimo SG. Minimally invasive surgery for urologic disease in children. ACTA ACUST UNITED AC 2007; 4:26-38. [PMID: 17211423 DOI: 10.1038/ncpuro0677] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2006] [Accepted: 11/03/2006] [Indexed: 11/09/2022]
Abstract
This article is a comprehensive review of the current indications and recent literature pertaining to laparoscopic techniques in pediatric urology. Basic concepts such as instrumentation, anesthetic considerations, and complications are reviewed. Specific techniques and indications are also explored. As the field of pediatric urology continues to expand, it still lags behind adult urology. With improvements in technology, however, and with new surgeons entering the field with a basic laparoscopic background, pediatric urologic laparoscopy continues to progress. Currently, procedures such as laparoscopic exploration for undescended testicles and laparoscopic nephrectomy are accepted as the 'gold standard', and are performed at most institutions. Other procedures, such as laparoscopic pyeloplasty and laparoscopic reconstructive surgery, have only recently been introduced and are primarily available at centers with surgeons experienced in laparoscopy. It is our hope that minimally invasive surgical approaches to urologic conditions will become available to all children and become commonplace at most institutions.
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Kiriakopoulos A, Tsakayanis D, Linos D. Bilateral Laparoscopic Transperitoneal Adrenalectomy in Three Children. J Laparoendosc Adv Surg Tech A 2006; 16:534-9. [PMID: 17004885 DOI: 10.1089/lap.2006.16.534] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND This study focuses on the clinical presentation, surgical technique, and results of bilateral laparoscopic adrenalectomy in three girls aged 6, 13, and 14. MATERIALS AND METHODS This retrospective study included two girls with bilateral tumors (pheochromocytomas in one case, recurrent leiomyosarcomas in the other case) and a girl with micronodular hyperplasia associated with Cushing's syndrome. RESULTS Six transperitoneal laparoscopic adrenalectomies were performed with no conversions. The average operative time was 137 minutes (range 125-148); the mean estimated blood loss was 75 mL; the mean size of the adrenal lesions was 8 cm (range, 0.5-9); and the mean length of hospital stay was 3 days (range, 2-4). Resolution of clinical and biochemical parameters of adrenal hyperfunction was accomplished in the patients with adrenocortical hyperplasia and pheochromocytoma. No tumor recurrence has been so far found in the case of the leiomyosarcomas. CONCLUSION Bilateral laparoscopic adrenalectomy can be performed safely and effectively with a shorter hospital stay, minimal blood loss, and excellent functional outcome in the pediatric population.
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Abstract
Neuroblastoma, a neoplasm of the sympathetic nervous system, is the most common solid extracranial tumor of childhood. Complete tumor resection has been shown to improve outcomes in both low- and high-risk neuroblastoma. The efficacy of laparoscopic adrenalectomy (LA) for metastatic lesions, benign tumors, and small neuroblastomas (<20 mm in diameter) is well established. However, the role of LA for large neuroblastomas is unclear. The authors describe the technical aspects of LA in 6 children with adrenal neuroblastomas greater than 2 cm and summarize their outcomes. All 6 patients underwent successful LA with removal of their tumors and surrounding lymph nodes. The specimens were placed in a laparoscopic specimen retrieval bag and morsulated in situ. The pathologic specimens were adequate for biologic factor analysis and histology. Mean operative time for all cases was 146 minutes. The average size of the adrenal tumors resected was 3.3 x 3.7 x 3.3 cm, and there were no intraoperative or perioperative deaths. All children, except the fifth patient who stayed for chemotherapy, were discharged home within 48 hours after surgery and are well. Our preliminary data suggest LA is a safe treatment option for neuroblastoma tumors greater than 2 cm in the select children.
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Affiliation(s)
- Daniel F Saad
- Division of Pediatric Surgery, Children's Healthcare of Atlanta at Egleston, Emory University, Atlanta, GA 30322, USA
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35
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Mirallié E, Cariou B, Kraeber-Bodéré F. Phéochromocytomes bilatéraux. Génétique et traitement. ACTA ACUST UNITED AC 2005; 130:273-6. [PMID: 15847867 DOI: 10.1016/j.anchir.2005.02.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- E Mirallié
- Clinique chirurgicale A, Hôtel-Dieu, CHU de Nantes, 44093 Nantes cedex 01, France.
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36
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de Lagausie P, Berrebi D, Michon J, Philippe-Chomette P, El Ghoneimi A, Garel C, Brisse H, Peuchmaur M, Aigrain Y. Laparoscopic adrenal surgery for neuroblastomas in children. J Urol 2003; 170:932-5. [PMID: 12913744 DOI: 10.1097/01.ju.0000081415.49550.01] [Citation(s) in RCA: 67] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE The role of laparoscopy in children with neuroblastomas has not been fully defined. The laparoscopic approach to the adrenal gland is already largely used in adults and a few cases have been reported in children. We report the experience of a single surgical team center with laparoscopic adrenal surgery for neuroblastomas in children. MATERIALS AND METHODS Between September 2000 and October 2002 laparoscopic adrenalectomy for neuroblastoma was performed in 9 patients (6 girls and 3 boys) with a mean age of 38 months (range 2 months to 9 years). Two tumors were detected prenatally and 7 postnatally. Preoperative diagnosis was neuroblastoma stage I in 4 cases and stage IV in 3 cases, and nondetermined suprarenal calcified masses in 2 cases. A 4 or 5-trocar transperitoneal approach was used in all cases. The adrenal tumors were completely excised, placed into a plastic bag and removed through the umbilical trocar site. RESULTS All of the adrenal tumors were well encapsulated and completely excised. One of the 9 procedures was converted to open surgery because of adhesions to renal vessels. In 1 case a second hepatic localization was removed simultaneously, and in 3 cases 1 or more lymph nodes were resected. Average operative time was 85 minutes (range 45 to 170). There were no deaths. There were no postoperative complications, except 1 port site infection that was treated locally. Blood transfusion was not required. Average hospital stay was 4.5 days (range 2 to 10). Histological analysis of the 9 specimens (maximum length 6 cm) confirmed the diagnosis of neuroblastoma. N-myc status was studied in 8 of the 9 resected neuroblastomas and was amplified in 2 cases (both stage IV with preoperative biopsy). Average postoperative followup was 15 months (range 1 to 25). There was no local recurrence or metastasis, except in the case that required conversion to open surgery (local recurrence 7 months later). CONCLUSIONS Laparoscopic adrenalectomy for neuroblastoma is safe and feasible in children, with good results. Experience with advanced laparoscopic surgery is required to achieve this result in optimal oncological conditions. Our short-term results must be reevaluated at long term, and further studies are needed to compare laparoscopy to open surgical techniques.
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Affiliation(s)
- P de Lagausie
- Department of Pediatric Surgery, Hôpital Robert Debré, AP-HOP Paris, 48 boulevard Serurier, 75019 Paris, France.
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Affiliation(s)
- Wendy R Sackett
- Department of Surgery, Royal North Shore Hospital, Sydney, New South Wales, Australia
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38
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Abstract
Laparoscopic adrenalectomy has become the procedure of choice for the surgical management of most adrenal tumors, including functional and non-functional lesions. The role of laparoscopic adrenalectomy in the management of malignant adrenal tumors is controversial and most adrenocortical cancers are generally treated by open adrenalectomy. Laparoscopic adrenalectomy can be performed by both the anterior or lateral trans-abdominal approach and by the lateral or posterior retro-peritoneal approach, with each method being suitable for specific indications. Although there are no randomized trials comparing laparoscopic with open adrenalectomy, the laparoscopic approach is associated with shorter hospital stay, reduced pain and improved cosmesis. This review discusses the indications and contraindications, technique and outcomes for laparoscopic adrenalectomy.
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Affiliation(s)
- Geeta Lal
- UCSF/Mt. Zion Medical Center, 1600 Divisadero Street, suite c347, San Francisco, CA 94143-1674, USA
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39
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Abstract
PURPOSE OF REVIEW Laparoscopic procedures in paediatric urology are gaining popularity, with an increasing number of centres performing advanced surgery. Indications have expanded from diagnostic to ablative surgery and more recently to reconstructive procedures. The current status of the indications and results of different laparoscopic procedures dealing with paediatric urology are reviewed. RECENT FINDINGS Laparoscopic orchiopexy for intra-abdominal testis gives better results than classic open surgery procedures. Palomo modified varicocelectomy with lymphatic preservation is the optimal surgical procedure to treat varicocele in adolescents. The retroperitoneal approach to renal surgery is gaining popularity. Total and partial nephrectomies are feasible in comparable operative times with open surgery and shortened hospital stays. Dismembered pyeloplasty remains a challenging procedure limited to few centres, with excellent midterm results. Laparoscopic adrenal surgery has been extended to neuroblastoma in selected cases. Laparoscopic transvesical ureteric re-implant is now feasible, and opens a new era in bladder surgery. Finally, results of the initial experience with robot-assisted pyeloplasty are now available in children, and showed similar results with regard to the postoperative course, but shorter operative times with experience. SUMMARY The value of laparoscopic orchiopexy for intra-abdominal testis and ablative surgery such as total and partial nephrectomy and adrenalectomy has been confirmed. Robot-assisted laparoscopic surgery will probably popularize challenging procedures such as pyeloplasty and ureterovesical re-implant, which are still limited to a few centres. Despite an increase in the number of publications dealing with the results of laparoscopic procedures, efforts are still needed to validate the benefits of such procedures over open surgery.
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Affiliation(s)
- Alaa El-Ghoneimi
- Department of Pediatric Surgery, Hôpital Robert Debré, Faculty of Medicine Bichat, University of Paris, France.
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Warmann S, Fuchs J, Jesch NK, Schrappe M, Ure BM. A prospective study of minimally invasive techniques in pediatric surgical oncology: preliminary report. MEDICAL AND PEDIATRIC ONCOLOGY 2003; 40:155-7. [PMID: 12518343 DOI: 10.1002/mpo.10234] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Thoracoscopic and laparoscopic techniques play a major role in pediatric surgery. However, minimally invasive surgery (MIS) has not yet established itself in pediatric surgical oncology. The authors present a prospective study investigating the role of MIS in children with cancer. PROCEDURE All children with abdominal or thoracic tumors requiring surgery were registered between September, 2000 and February, 2002. Decisions regarding procedures and approaches-conventional or minimally invasive-were made by the interdisciplinary team. Data on diagnoses, surgical procedures, complications, and conversion rates were registered prospectively. RESULTS Seventy-four patients received 78 operations, 21 (26.9%) of the 78 operations were minimally invasive. Seven of 16 tumor biopsies (43.8%) and 9 of 57 tumor resections (15.8%) were performed using MIS, which was also exclusively used for diagnostic interventions. Conversions to standard techniques only occurred in 5 of 9 tumor resections. No major complications were encountered in the MIS group. CONCLUSIONS MIS was practical in every fourth patient in our experience so far. It proved to be an excellent approach in diagnostic interventions and tumor biopsies, whereas efficacy is limited in tumor resections. Further factors (tumor recurrence, trocar site recurrence, tumor growth, and dissemination after CO(2) insufflation) have to be evaluated. Our data encourage the continuation of the study.
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Affiliation(s)
- Steven Warmann
- Department of Pediatric Surgery, Hannover Medical School, Carl-Neuberg-Str. 1, Hannover, Germany
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Van YH, Wang HS, Lai CH, Lin JN, Lo FS. Pheochromocytoma presenting as stroke in two Taiwanese children. J Pediatr Endocrinol Metab 2002; 15:1563-7. [PMID: 12503867 DOI: 10.1515/jpem.2002.15.9.1563] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Pheochromocytoma is a rare tumor and accounts for about 1% of pediatric hypertension. Its diagnosis is important because the hypertension is usually curable by eradication of the tumor. We report two Taiwanese children with pheochromocytoma presenting as stroke. Patient 1 developed a cerebral infarction and patient 2 had an intracranial hemorrhage. Abdominal MRI of patient 1 showed an extraadrenal tumor 5.1 x 4 x 4.7 cm in size and abdominal CT of patient 2 revealed a left adrenal mass 4 x 2.9 x 4 cm in size. 24-h urinary excretion of norepinephrine for patients 1 and 2 were 1480.8 and 3279 microg/day, respectively. Preoperative alpha- and beta-adrenergic blockade was used for hypertension control. Both patients underwent successful tumor resection, upon which blood pressure and 24-h urinary excretion of catecholamines returned to normal without any further medication. They have been free from hypertension for 4 years (patient 1) and 2 years (patient 2).
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Affiliation(s)
- Yang-Hau Van
- Division of Endocrinology, Chang Gung Children 's Hospital, Taoyuan, Taiwan
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Abstract
Recent improvements in laparoscopic equipment, technique, and skills have contributed to advancement of the laparoscopic approach to even relatively rare pediatric surgical diseases. Two invasive operations that now may be approached laparoscopically are adrenalectomy and esophagomyotomy. Both techniques, initially described in the early 1990s, are particularly well suited for the laparoscopic approach and have become accepted as the preferred technique among general surgeons. Despite infrequent indications for either of these operations in children, pediatric surgeons experienced in minimally invasive techniques may apply the laparoscopic approach in a safe and effective manner. Furthermore, regarding achalasia in the pediatric population specifically, the offering of a less-invasive surgical approach may contribute toward more primary definitive surgical management being offered initially rather than after prolonged supportive medical care. The goal of this article is to familiarize the reader with the current laparoscopic approach to benign pediatric adrenal conditions and esophageal motility disorders in children.
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Affiliation(s)
- Kelly A Miller
- Department of Surgery, Children's Hospital of Pittsburgh, PA, USA
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43
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Easter DW, Katz M. Laparoscopic adrenalectomy for pheochromocytoma--a new standard? CURRENT SURGERY 2002; 59:450-4. [PMID: 15727788 DOI: 10.1016/s0149-7944(02)00630-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Affiliation(s)
- David W Easter
- Department of Surgery, University of California at San Diego, San Diego, California, USA
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Affiliation(s)
- Lísias N. Castilho
- From the Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil, and Clínica Santa Maria, Santiago, Chile
| | - Octavio A. Castillo
- From the Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil, and Clínica Santa Maria, Santiago, Chile
| | - Francisco T. DÉNes
- From the Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil, and Clínica Santa Maria, Santiago, Chile
| | - Anuar I. Mitre
- From the Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil, and Clínica Santa Maria, Santiago, Chile
| | - Sami Arap
- From the Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil, and Clínica Santa Maria, Santiago, Chile
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Miller KA, Albanese C, Harrison M, Farmer D, Ostlie DJ, Gittes G, Holcomb GW. Experience with laparoscopic adrenalectomy in pediatric patients. J Pediatr Surg 2002; 37:979-82; discussion 979-82. [PMID: 12077753 DOI: 10.1053/jpsu.2002.33822] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND Laparoscopic adrenalectomy (LA) is now being recognized as the standard in the management of benign adrenal pathology in adult patients. Few reports have described the use of this technique in pediatric patients. This study combines experience from 2 institutions with lateral transperitoneal LA in children to analyze our results and the clinical and biochemical response to laparoscopic adrenalectomy in patients with hormonally active adrenal tumors. METHODS A bi-institutional retrospective review of all patients undergoing LA between January 1997 and January 2001 was performed. Clinical and biochemical data were obtained during routine follow-up. RESULTS Seventeen laparoscopic adrenalectomies were performed during this period. The average operating time was 120 minutes, mean estimated blood loss was 25 mL, the mean size of the adrenal lesion was 4.8 cm, and the mean length of hospitalization was 35 hours. Resolution of clinical and biochemical parameters of adrenal hyperfunction was accomplished in all patients with adrenocortical hyperplasia and pheochromocytoma in postoperative follow-up. CONCLUSIONS Laparoscopic adrenalectomy can be performed safely and effectively with a short hospital stay, minimal blood loss, and excellent functional outcome in this age group. The authors believe laparoscopic adrenalectomy is an excellent approach for the management of benign pediatric adrenal pathology.
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Affiliation(s)
- K A Miller
- Children's Mercy Hospital, University of Missouri at Kansas City School of Medicine, Kansas City, MO 64108, USA
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Abstract
More sophisticated endoscopic instruments, combined with a better understanding of bladder and urethral pathology, have significantly improved the therapeutic approaches for both posterior urethral valves and ureteroceles. New generation lithotripters have allowed for a safe and efficient method of treating urinary calculi in children, which was once thought too injurious a process with first-generation machines. The rapidly advancing field of laparoscopy, aided by the development of more optically refined and diminutive instruments, has allowed for its application in a wide variety of surgical interventions in pediatric urology. The tubularized incised plate urethroplasty has challenged more traditional approaches to hypospadias repair and is now considered by many pediatric urologists to be the best approach for midshaft and distal hypospadias. The one-stage approach to exstrophy repair may hold the answer to improved continence without a formal bladder neck reconstruction. Finally, the field of tissue engineering leads the way to new advances in autologous biological substitutes in the surgically-challenged patient where there is a shortage of local tissues at the surgeon's disposal.
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Affiliation(s)
- R E De Filippo
- Department of Urology, Children's Hospital and Harvard Medical School, Boston, Massachusetts 02115, USA
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