LAPAROSCOPIC NEPHRECTOMY IN CHILDHOOD - I NDICATION, TECHNIQUE AND 1ST RESULTS

The advantages of laparoscopic interventions such as less traumatisati on to the patient and shorter convalescent periods and hospitalization have led to increasing use of this operative technique in pediatric s urgery. Laparoscopic nephrectomy is especially indicated for small or hydronephrotic kidneys. On the basis of three cases the technique of t ransperitenel laparoscopic nephrectomy is demonstrated. For hypoplasti c kidneys, preoperative insertion of an ureteric catheter with primary exposure and mobilisation of the ureter is recommended. This is follo wed by dissection from the ureter towards the kidney. In cases of hydr onephrosis, removal is facilitated by mobilizing the kidney before the renal vessels are exposed. Hydronephrotic kidneys can be mobilized mo re clearly starting from the kidney itself, before they are removed fr om the renal vessels. Depending on the size of the renal vessels, hemo stasis is secured by clips and/or endoligatures. As the laparoscopic t echnique of nephrectomy is relatively difficult, it should be performe d only by surgeons experienced in the field of laparoscopic operations .