title: [Complications in laparoscopy renal surgery in pediatric age: analysis of our experience and literature review].
abstract: BACKGROUND
  The development of the minimally invasive surgery in pediatric age has been slower than in the adult age since their advantages are not so clear. The learning curve and the complications presented during this period, as well as the type of material used has been the factors that have contributed to this fact.
  
  
  OBJECTIVE
  We collected our experience and the complications presented in renal laparoscopic exegesis surgery, adding a review of the published literature to date.
  
  
  METHODS
  Retrospective study of our clinical cases in that we practiced laparoscopic renal exegesis surgery. We collected 56 cases from January 2003, when it was implanted, to September 2008. We had 36 boys (64%) and 20 girls (36%). The mean age was 3.6 years. We analyzed principal diagnosis, the situation that conducted to the surgery and the type of surgery performed, time of surgery, hospital stay and complications with their solution. The results were analyzed the statistical program SPSS (SPSSCorp, Chicago, Illinois). The literature review was practiced in MEDLINE, EMBASE and COCHRANE database. The selected works were reviewed by two investigators. Series containing adults were excluded.
  
  
  RESULTS
  We perfomed 42 nephrectomies (75%), 13 heminephrectomies (23%) and 1 quistectomy (2%). 5 cases (9%) were done by retroperitoneoscopy and 51 cases (91%) transperitoneally. The mean operative time was 118 +/- 0,75 min, for nephrectomies; 192 +/- 1.07 min, for partial nephrectomies, 111 +/- 0,64 for nephroureterectomies and 240 min for quistectomia. The mean hospital stay was 3.18 min (2-6) days for nephrectomies; 5.91 (3-11) days for partial nephrectomies, 3 days (2-4) for nephroureterectomies and 6 days for the quistectomy. We had 8 complications (14%): 2 conversions for bledding and technical difficulty and 6 postoperative complications (3 were minor complications, postoperative fever and 3 mayor (2 Urinomas and one pseudoaneurism, requiring 2 interventions and one catheter double J placement). The evolution has been satisfactory in all cases. In the bibliographic review 47 articles with a level of evidence IIIB were selected (Oxford Centers for Evidence-based Medicine). The main reasons to conversion to open surgery were vascular problems and the complication rate change from anyone to 37%.
  
  
  CONCLUSIONS
  Laparoscopic surgery has proved to be a secure and feasible technique in the treatment of benign renal pathology in pediatric age with satisfactory results. Actually the indications are expanding to reconstructive procedures, with promising results, and selected oncologic procedures.
authors.affiliation: Servicio de Urología, Hospital Universitario Virgen Macarena, Sevilla, España. alblorca@yahoo.es
authors.forename: Alberto Pérez-Lanzac
authors.initials: AP
authors.lastname: de Lorca
authors.forename: Andrés Gómez
authors.initials: AG
authors.lastname: Fraile
authors.forename: Adolfo Aransay
authors.initials: AA
authors.lastname: Bramtot
authors.forename: Daniel Cabezalí
authors.initials: DC
authors.lastname: Brabancho
authors.forename: Francisco López
authors.initials: FL
authors.lastname: Vázquez
authors.forename: Jesús Castiñeiras
authors.initials: JC
authors.lastname: Fernández
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007674:Kidney Diseases / Q000601:surgery*; D010535:Laparoscopy / Q000009:adverse effects*; D008297:Male; D009392:Nephrectomy / Q000009:adverse effects* / Q000379:methods*; D012189:Retrospective Studies