Laparoscopic retroperitoneal nephrectomy in high risk children

Purpose: Nephrectomy may be indicated in children with end stage renal dise ase before transplantation. We studied the feasibility and results of nephr ectomy performed via a retroperitoneal laparoscopic approach in these high risk children. Materials and Methods: We performed 12 nephrectomies in 9 children with end stage renal disease and a mean age of 7 years (range 7 months to 13 years) through a 3 trocar retroperitoneal laparoscopic approach. Cases were class ified as American Society of Anesthesiologists grade III and presented with end stage renal disease, hypertension, thrombocytopenia and/or the nephrot ic syndrome. The renal artery and vein were ligated separately with endocor poreal knots and clips. Mean size of the kidney was 8 cm. (range 5 to 12). Bilateral nephrectomy was performed simultaneously in 2 patients 7 and 12 m onths old, respectively. Cardiorespiratory changes related to retroperitone al gas insufflation were assessed prospectively. To compare laparoscopic Ve rsus open nephrectomy we retrospectively analyzed the data of 12 open nephr ectomies performed in 9 children with similar nephrological indications. Results: The procedure was feasible in all cases without conversion to open surgery, and no intraoperative incident occurred. Mean operative time of l aparoscopic nephrectomy was 2 hours (range 1 hour 20 minutes to 3 hours 10 minutes). After retroperitoneal carbon dioxide insufflation systolic arteri al pressure and end-tidal carbon dioxide were significantly increased witho ut the need for specific measure to correct these modifications. Hemodialys is began 1 day postoperatively and feeding began 2 days postoperatively. Me an hospital stay was 5.2 days (range 3 to 7). The comparative study of the open nephrectomy group showed no significant difference in mean operating t ime (p = 0.07), and hospital stay was significantly shorter for the laparos copic group (p <0.001). Conclusions: Retroperitoneal laparoscopic nephrectomy is safe and feasible for high risk children. The relatively long operating time is necessary for hemostasis in these children at risk for hemorrhagic complications.