Laparoscopic nephroureterectomy in children: a prospective study on Ligasure versus Clip/Ligation.
OBJECTIVE
The present study was performed to compare dissection of the renal hilar vessels in laparoscopic transabdominal nephrectomy in children using the Endo-Ligasure vessel sealing system versus clip/ligation.


METHODS
In a prospective and comparative study carried out from February 2003 to April 2004, 10 consecutive patients (group 1) underwent laparoscopic transabdominal nephroureterectomy using clips or intracorporeally performed ligations, respectively. From April 2004 to April 2005, 10 consecutive patients (group 2) underwent the same procedure using the Endo-Ligasure vessel sealing system. Indications for surgery were confirmed non-functioning kidneys secondary to benign unilateral renal disease and no prior surgery. The age and underlying disease distribution and the affected side were not significantly different between the two groups.


RESULTS
The operating time was significantly lower in the Endo-Ligasure group (group 1: median 167 vs. group 2: 108 min, p < 0.05). Bleeding of the renal artery occurred due to dislocation of a suture ligation, which was treated laparoscopically with an intracorporeal suture ligation. Blood loss was negligible in all patients. All procedures were completed laparoscopically and recovery was uneventful.


CONCLUSIONS
Endo-Ligasure is a beneficial tool in laparoscopic transabdominal nephrectomy. It is safe, effective, and reduces operating times compared to clip application and intracorporeal suturing.
Metzelder
M L
ML
Department of Pediatric Surgery, Hannover Medical School, Hannover, Germany. metzelm@web.de
Kübler
J
J
Petersen
C
C
Glüer
S
S
Nustede
R
R
Ure
B M
BM
D016063:Blood Loss, Surgical; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D010535:Laparoscopy; D008026:Ligation / Q000295:instrumentation*; D008297:Male; D009392:Nephrectomy / Q000295:instrumentation*; D011446:Prospective Studies; D013525:Surgical Instruments; D013537:Sutures; D013997:Time Factors; D014513:Ureter / Q000601:surgery*