title: Single-incision laparoscopic nephroureterectomy in children of all age groups.
abstract: OBJECTIVE
  The purpose of this study was to assess different surgical approaches for laparoendoscopic single-site nephroureterectomy according to weight groups.
  
  
  METHODS
  LESS nephroureterectomy was performed in 11 children. Indication for nephrectomy was a non-functioning kidney owing to vesicoureteral reflux or giant cystic dysplasia. Children below 10 kg body weight underwent LESS nephroureterectomy through an umbilical incision using one 5mm and two 3mm trocars (Manhattan technique). Patients above 10 kg were operated on using a metal multi-use single-site single port (X-Cone).
  
  
  RESULTS
  Median age at operation was 12 months (0.75-128), and median weight was 8.5 kg (3.1-67). Median operating time was 110 minutes (50-260). Eight children underwent LESS nephroureterectomy using the Manhattan-technique, and three patients were operated on with the X-Cone. All operations were carried out in a transperitoneal technique without using additional trocars. There were no complications. Recovery was uneventful in all children.
  
  
  CONCLUSIONS
  LESS nephroureterectomy for pediatric patients can be done safely and efficiently, irrespective of age and weight. However, different surgical approaches have to be considered owing to the fact that single-site ports are not available for small children and infants. Both techniques will benefit from future development of instruments and trocars more suitable for small children. The question whether LESS provides even less trauma than in conventional laparoscopy remains doubtful.
authors.affiliation: Department of Pediatric Surgery and Pediatric Urology, University Children's Hospital, Hoppe-Seyler-Strasse 3, 72076, Tuebingen, Germany. tobias.luithle@med.uni-tuebingen.de
authors.forename: Tobias
authors.initials: T
authors.lastname: Luithle
authors.forename: Philipp
authors.initials: P
authors.lastname: Szavay
authors.forename: Jörg
authors.initials: J
authors.lastname: Fuchs
mesh_terms: D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D009392:Nephrectomy / Q000379:methods*; D007690:Polycystic Kidney Diseases / Q000601:surgery; D011183:Postoperative Complications / Q000453:epidemiology; D011446:Prospective Studies; D016896:Treatment Outcome; D014513:Ureter / Q000601:surgery*; D014718:Vesico-Ureteral Reflux / Q000601:surgery