Laparoscopic partial upper pole nephrectomy in infants and children

Objective To retrospectively review 5 years' experience of transperitoneal laparoscopic partial nephrectomy (LPN) in infants and children. Patients and methods Between January 1995 and December 1999, 14 upper-pole partial nephrectomies (seven right and seven left) were undertaken in 13 ch ildren (mean age 3.8 years, range 0.4-14). One patient underwent bilateral upper-pole LPN. No children required a lower-pole partial nephrectomy durin g the study period. Evaluation included renal ultrasonography. voiding cyst ourethrography. renal scintigraphy and contrast-enhanced computed tomograph y in some cases. Three ports (10, 5 and 5 mm) were used in all except two p atients, who required an additional 2 mm port for liver retraction. The dis eased parenchyma was transected with electrocautery or harmonic scalpel. Th e distal ureter was simply transected in the absence of reflux, but tied ad jacent to the bladder if reflux was present. Results The mean operative duration for LPN was 100 min, with an estimated blood loss of < 30 mL. A liquid diet was tolerated on the first morning aft er surgery and age-appropriate regular diet that evening in all except one patient. The mean hospital stay was 2.6 days. One patient bad a significant decrease in haematocrit, which was managed conservatively, not requiring t ransfusion. Follow-up telephone interviews with the patients' parents showe d that all were satisfied with the medical and cosmetic outcome. Conclusion Transperitoneal LPN is preferable to open partial nephrectomy be cause: (i) The magnification provided by laparoscopy provides excellent vis ion for the precise dissection of the parenchyma and distal ureter, avoidin g injury to the healthy tissue: (ii) There is minimal blood loss, fast reco very and less surgical scarring, and when upper-pole partial nephrectomy is required. LPN is less damaging to the lower-pole. Unlike total nephrectomy , where debate remains about open vs laparoscopic methods, the specific adv antages of LPN make it clearly preferable.