Single-incision laparoscopic nephrectomy and heminephroureterectomy in young children using conventional instruments: first report of initial experience.
OBJECTIVE
To report the surgical technique and the early outcomes of nephrectomy and heminephroureterectomy by single-incision laparoscopic surgery (SILS) in children using conventional laparoscopic instruments only.


METHODS
Three consecutive children (aged 3, 4 and 7 years) who underwent nephrectomy for multicystic dysplastic kidney (n = 2) and upper moiety heminephroureterectomy for duplex kidney (n = 1) by SILS were retrospectively reviewed. A standardized infraumbilical incision was used for the insertion of 3 reusable ports of 3 and 5 mm. The SILS procedure was performed by the technique of crossing 2 straight instruments.


RESULTS
All 3 procedures were successfully performed by SILS without any intraoperative complications or need for conversion. The 2 nephrectomies were each completed in 120 minutes, whereas the heminephroureterectomy took 400 minutes. Only 1 dose of narcotic analgesic was required by 1 patient, and 2-6 doses of oral acetaminophen were taken for postoperative pain control. All 3 children recovered smoothly from surgery without complications.


CONCLUSIONS
Nephrectomy and heminephroureterectomy by SILS using conventional instruments are technically feasible in young children. Further studies are required to investigate whether the SILS approach can become a sound alternative to standard laparoscopy.
Division of Paediatric Surgery and Paediatric Urology, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China. pyhtam@hotmail.com
Yuk Him
YH
Tam
Jennifer Dart Yin
JD
Sihoe
Sing Tak
ST
Cheung
Kim Hung
KH
Lee
Kin Wai
KW
Chan
Kristine Kit Yi
KK
Pang
D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007668:Kidney / Q000002:abnormalities; D010535:Laparoscopy / Q000295:instrumentation / Q000379:methods*; D008297:Male; D019060:Minimally Invasive Surgical Procedures; D009392:Nephrectomy / Q000295:instrumentation / Q000379:methods*; D007690:Polycystic Kidney Diseases / Q000601:surgery; D014513:Ureter / Q000601:surgery*