Laparoscopic nephrectomy in children

Background: Laparoscopic nephrectomy in the adult population is reported wi th increased frequency. We present our initial experience with laparoscopic nephrectomy in children. Methods: Over a 2-year period, 11 nephrectomies were per formed in nine chi ldren aged 16 months to 16 years (mean, 6.5 years). All patients were refer red due to complications of a nonfunctioning kidney. Seven patients had rec urrent urinary tract infections, and two had refractory hypertension. Two p atients underwent bilateral laparoscopic nephrectomy. The operation was per formed using four access ports measuring 3.5 to 10 mm. Results: All kidneys were removed successfully using a laparoscopic techniq ue. The average length of the operation was 163 min per kidney (range, 90-4 20). The estimated blood loss was <10-150 mi (mean, 45). No patient require d transfusion. Seven patients were discharged home by postoperative day 2. The two patients with the longest operating times were discharged home on p ostoperative days 4 and 5 due to delay in return of bowel function. Narcoti c use was minimal, and all patients enjoyed a rapid return to full activity . Conclusion: Laparoscopic nephrectomy is a viable alternative to open nephre ctomy in children. Further experience with this technique is required to es tablish its efficacy and reduce the operating time.