title: Comparison of laparoendoscopic single-site, conventional laparoscopic, and open nephrectomy in a pediatric population.
abstract: BACKGROUND
  We provide a single-institution comparison of open, conventional laparoscopic (CL) and laparoendoscopic single-site (LESS) nephrectomy in children.
  
  
  METHODS
  We identified all nephrectomy cases occurring at Rady Children's Hospital from July 2007 to March 2010. Exclusion criteria included redo/bilateral operations, malignancy, transplant nephrectomy, or complex urogenital anomalies. We compared patient demographics, total operative times, estimated blood loss (EBL), length of stay (LOS), complication rates, postoperative pain score, narcotic usage, and total hospital costs.
  
  
  RESULTS
  We identified 7 LESS, 11 CL, and 8 open nephrectomy patients who met our criteria. The mean age of patients was 8.5, 7.3, and 4.2 years for LESS, CL, and open nephrectomy, respectively (P=.217). Operative times were 192.2, 219.3, and 127.4 minutes for LESS, CL, and open nephrectomy, respectively (P=.076). EBL was 15, 13.2, and 12.5 mL, respectively, for these groups (P=.871). There were no complications in any of the groups, although 1 LESS patient required conversion to open nephrectomy for bleeding. Mean LOS was 46.8, 36.9, and 33.8 hours in the LESS, CL, and open nephrectomy groups (P=.308). Mean pain scores on postoperative day 1 were 2.3, 1.8, and 1.6 in each group, respectively (P=.518). Hospital costs were comparable between the LESS and CL groups. The mean cost for open nephrectomy was 54.4% the mean cost for CL, however (P=.001).
  
  
  CONCLUSIONS
  LESS nephrectomy in children is safe and overall comparable with CL. In our experience, no modality confers a distinct advantage except for the decreased cost associated with open surgery.
authors.affiliation: Division of Urology, University of California, San Diego, Medical Center, and Rady Children's Hospital, San Diego, California 92123, USA.
authors.forename: Jeffrey M
authors.initials: JM
authors.lastname: Woldrich
authors.forename: Nicholas
authors.initials: N
authors.lastname: Holmes
authors.forename: Kerrin
authors.initials: K
authors.lastname: Palazzi-Churas
authors.forename: Madhu
authors.initials: M
authors.lastname: Alagiri
authors.forename: Marvalyn
authors.initials: M
authors.lastname: DeCambre
authors.forename: George
authors.initials: G
authors.lastname: Kaplan
authors.forename: George
authors.initials: G
authors.lastname: Chiang
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D006801:Humans; D007223:Infant; D010535:Laparoscopy / Q000379:methods*; D009392:Nephrectomy / Q000379:methods*; D012189:Retrospective Studies