Retroperitoneoscopic nephroureterectomy via three trocars in pediatric patients with end-stage reflux nephropathy.
OBJECTIVE
In children with end-stage reflux nephropathy, nephroureterectomy can be performed either open or laparoscopically. It is not common to use a three-trocar retroperitoneal approach for nephroureterectomy with complete ureteral excision in the pediatric age group. We report the results of pediatric retroperitoneoscopic nephroureterectomies by using three trocars only.


METHODS
Between August 2003 and November 2009, 13 children-seven boys and six girls-with end-stage reflux nephropathy underwent retroperitoneoscopic nephroureterectomy. The operations were performed by using three trocars with the patient in a flank position under general anesthesia. Renal blood vessels were individually dissected and divided followed by the transection of the ureter at the level of the ureterovesical junction.


RESULTS
The mean age of the patients was 6.5 ± 4.4 years (15 months-14 years). Eight of the operations were performed on the left and five on the right side. Mean operative time was 137 ± 47 minutes (75-230 min). Estimated blood losses were minimal. Mean hospitalization time was 2.2 ± 0.9 days (2-5 d). No major intraoperative complication was seen. Overall postoperative analgesic requirement was minimal. Cosmetic results were excellent at the initial postoperative visit.


CONCLUSIONS
Retroperitoneoscopic nephroureterectomy by using three trocars is feasible and safe with excellent outcomes in pediatric patients with end-stage reflux nephropathy.
Kuzgunbay
Baris
B
Department of Urology, Cukurova University, Adana, Turkey. kuzgunbay33@yahoo.com
Bayazit
Yildirim
Y
Bayazit
Aysun K
AK
Satar
Nihat
N
D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D008026:Ligation; D008297:Male; D009392:Nephrectomy / Q000295:instrumentation* / Q000379:methods*; D012187:Retroperitoneal Space / Q000601:surgery*; D013525:Surgical Instruments; D014513:Ureter / Q000601:surgery*; D014718:Vesico-Ureteral Reflux / Q000601:surgery*