Pediatric transperitoneal laparoscopic partial nephrectomy: comparison with an age-matched group undergoing open surgery.
We have retrospectively evaluated the effectiveness of laparoscopic transperitoneal partial nephrectomy (LTPN) in children in comparison to an age-matched group of children who underwent open partial nephrectomy (OPN) in terms of safety, operative time, narcotic requirements and the length of hospitalization. All patients were divided into two groups. The first group of 10 children with a mean age of 3.6 +/- 1.3 years (mean +/- SEM) who underwent LTPN compared with an age and gender matched second group of 10 children with a mean age of 3.9 +/- 1.4 years who underwent OPN (P = 0.9119). In the first group, 5 upper poles and 5 lower poles partial nephrectomies were performed while in the second group 6 upper moieties and 4 lower moieties partial nephrectomies were performed, respectively. There was a single complication in each group. Intraoperative injury to the unaffected ureter was recognized during LTPN and required conversion to the open surgery in the beginning of learning curve and persistent urinary leakage from collecting system of the remnant pole in the OPN group, which resolved spontaneously. There was no difference in length of surgery and the intraoperative narcotic requirements (P = 0.8182, 0.7638, respectively). However, postoperative narcotic requirements were significantly lower in the first group 0.56 +/- 0.29 mg/kg compared to the second group 2.13 +/- 0.3 mg/kg, P = 0.0019. LTPN patients had significantly shorter hospitalization 2.7 +/- 0.29 days compared with the OPN group 5.1 +/- 0.64 days, P = 0.0039. Similar findings were also found in the subgroup of patients younger than 2 years. Median follow up in each group was 28 and 36 months, respectively. Our data show that LTPN is a safe and effective minimally invasive procedure at every age. It has an equivalent operative time, shorter hospitalization and lower postoperative narcotic requirements compared to the open approach.
Chertin
Boris
B
The Section of Pediatric Urology, Israel Urological Association, Jerusalem, Israel. bchertin@yahoo.com
Ben-Chaim
Jacob
J
Landau
Ezekiel H
EH
Koulikov
Dmitry
D
Nadu
Andrei
A
Reissman
Petachia
P
Farkas
Amicur
A
Mor
Yoram
Y
D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007668:Kidney / Q000002:abnormalities* / Q000601:surgery; D007674:Kidney Diseases / Q000151:congenital / Q000601:surgery*; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D009392:Nephrectomy / Q000379:methods*; D010537:Peritoneum; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome