title: Paediatric computer-assisted retroperitoneoscopic nephrectomy compared with open surgery.
abstract: OBJECTIVE
  Computer-assisted laparoscopic surgery (CALS) in children is increasingly used and has proven to be feasible and safe. However, its full potential remains unclear and clinical comparative studies hardly exist. The aim of this study was to prospectively evaluate our experience with CALS for performing retroperitoneal nephrectomies in children when compared with controls undergoing open surgery in terms of safety, operative time, blood loss, opoid requirements, the duration of hospital stay and complications.
  
  
  METHODS
  Computer-assisted retroperitoneoscopic nephrectomy was undertaken in ten consecutive children, mean age at the time of surgery 6.4 (SD ± 4.5) years, and compared with a retrospectively collected control group of all other children, mean age 3.9 (SD ± 4.6) years, who underwent the same procedure by conventional open surgery between the years 2005 and 2009. The endpoint of the study was 1 month postoperatively.
  
  
  RESULTS
  Nephrectomies were performed in all the children and no child was excluded from the study. There was no per-operative complication in any of the groups. The median (range) operative time was 202 (128-325) and 72 (44-160) min for the CALS and open group, respectively. The blood loss was minimal (<20 ml) for all the patients. The postoperative opoid requirements did not differ. The median (range) postoperative hospital stay was 1 (1-4) and 2 (1-7) days for the CALS and the open group, respectively. One complication in the form of an urinoma appeared 5 days after surgery in the CALS group.
  
  
  CONCLUSIONS
  Computer-assisted retroperitoneoscopic nephrectomy is a safe, feasible and effective procedure in children. Even though operative times are longer the patients benefit from the lower morbidity, improved cosmetics and shorter hospitalization associated with the minimally invasive approach.
authors.affiliation: Department of Paediatric Surgery, Children's Hospital Lund, Skåne University, 205 02, Malmö, Sweden. magnus.anderberg@skane.se
authors.forename: Magnus
authors.initials: M
authors.lastname: Anderberg
authors.forename: Christina Clementson
authors.initials: CC
authors.lastname: Kockum
authors.forename: Einar
authors.initials: E
authors.lastname: Arnbjörnsson
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007674:Kidney Diseases / Q000601:surgery*; D010535:Laparoscopy / Q000379:methods*; D007902:Length of Stay; D008297:Male; D009392:Nephrectomy / Q000379:methods*; D012187:Retroperitoneal Space / Q000601:surgery*; D012189:Retrospective Studies; D012371:Robotics; D025321:Surgery, Computer-Assisted / Q000379:methods*; D016896:Treatment Outcome