Laparoscopic upper-pole nephroureterectomy in infants.
OBJECTIVE
Report the results of laparoscopic upper-pole nephroureterectomy in infants.


METHODS
Six consecutive infants underwent 7 laparoscopic upper-pole nephroureterectomy. Pre and postoperative evaluation included renal sonography, voiding cystourethrogram and renal scintigraphy. All infants showed upper-pole exclusion. Surgery was performed through a transperitoneal approach with full flank position in all infants. Three or 4 ports were used according to the necessity of retracting the liver. The distal ureter was ligated close to the bladder whenever reflux was present and the dysplastic upper-pole was divided with the help of an electrocautery. Data regarding operative time, postoperative use of analgesics, time to resume oral feeding, hospital stay and tubular function were collected and analyzed.


RESULTS
All procedures were concluded as planned. Mean operative time was 135 min. One patient underwent staged bilateral upper-pole nephrectomy. There were no complications and the postoperative hospital stay was 48 hours in 5 procedures and 24 hours in 2 procedures. Pain medication was required only in the first day. Renal tubular function showed improvement in half of the cases.


CONCLUSIONS
Laparoscopic partial nephrectomy is a safe and feasible procedure in infants. Due to the magnification provided by the lenses, a better vision of the structures is achieved, facilitating selective dissection of vascular upper-pole, renal parenchyma and distal ureter. This approach is less damaging to the lower pole, and is associated to low morbidity and a short hospital stay.
Miranda
Marcio L
ML
Division of Genitourinary Surgery, Pediatric Surgery Unit, State University of Campinas, Unicamp, Campinas, Sao Paulo, Brazil. marciomiranda@terra.com.br
Oliveira-Filho
Antonio G
AG
Carvalho
Patricia T
PT
Ungersbock
Elaine
E
Olimpio
Hugo
H
Bustorff-Silva
Joaquim M
JM
D002908:Chronic Disease; D005260:Female; D006801:Humans; D007223:Infant; D007668:Kidney / Q000002:abnormalities* / Q000601:surgery*; D010535:Laparoscopy / Q000379:methods*; D007902:Length of Stay; D008297:Male; D009392:Nephrectomy / Q000379:methods*; D011704:Pyelonephritis / Q000175:diagnosis / Q000601:surgery*; D014513:Ureter / Q000601:surgery