Over a 40-month period, 24 consecutive children (1-15 years) underwent
laparoscopic nephrectomy. The indication for surgery was a poorly fun
ctioning kidney (<6% on DMSA isotope scanning) secondary to a variety
of causes, with or without pain or infection. Four cannulas were used
in each patient. The kidney was approached through a small incision in
the upper paracolic gutter without mobilization of the colon. The pro
cedure was successful in all but one child, who had conversion to open
technique because of poor laparoscopic viewing. In 12 children who re
quired nephroureterectomy, the distal ureter was approached by an open
technique through either a small extension of the iliac fossa cannula
site or a Pfannenstiel incision for combined bladder surgery, The ave
rage operating time for laparoscopy was 85 (range 40-160) minutes, The
children undergoing nephrectomy or nephroureterectomy alone had an av
erage hospital stay of 2 (range 1-4) days, There were no laparoscopic
or surgical complications. Laparoscopy provides a safe and successful
approach to pediatric nephrectomy, The technique combines well with an
open approach to the distal ureter when nephroureterectomy is indicat
ed.