ROLE OF LAPAROSCOPIC SURGERY IN PEDIATRIC UROLOGY

Objectives: In our clinic, laparoscopy was introduced in 1987 for the exploration of nonpalpable testes and since 1991 it has also been appl ied with therapeutic aims, We present our experience with this minimal ly invasive technique in pediatric patients. Patients and Methods: Bet ween May 1987 and September 1996, 219 laparoscopic procedures were per formed in children. All children received general anesthesia. Position ing of the patient on a rotatable and tiltable operating table is very important. Results: All laparoscopic interventions were well tolerate d in children, The operative time for exploration of a nonpalpable tes tis ranged from 10 to 30 min, and for varix ligation from 15 to 30 min . In nephrectomy and nephroureterectomy cases 80-150 min were required . The excision of the urachal remnant and the drainage of lymphocele t ook between 30 and 70 min. No immediate postoperative complications we re observed. Mobilization and oral intake were routinely carried out o n the day of surgery. The children required little or no postoperative pain medication. Conclusion: Laparoscopy has been found to be the mos t reliable diagnostic tool in evaluating nonpalpable testes within the pediatric population. This approach enables subsequent therapy of lap aroscopic orchiectomy, primary laparoendoscopic orchidopexy, or laparo scopically assisted two-stage Fowler-Stephens maneuver. Laparoscopic v arix ligation is a simple and highly effective treatment modality for the pubescent male with a symptomatic varicocele. To date, the recurre nce rate is 1.8% based on 80 patients followed for over 1 year. Fenest ration of lymphoceles following renal transplantation has been found t o be as efficaciously treated with laparoscopy as with open surgery. L aparoscopic nephrectomy and/or nephroureterectomy are technically dema nding procedures and should only be performed by an experienced laparo scopic surgical team to minimize the complication rate. At the present time, the intraoperative costs of laparoscopic surgery are greater th an with open surgery due to the use of disposable instrumentation and longer operating room times. However, minimally invasive surgery conti nues to gain a greater and more important role in the field of pediatr ic urology.