title: Laparoscopic partial nephrectomy in duplex kidneys in infants and children: results of an European multicentric survey.
abstract: BACKGROUND
  We aim to report a 5-year retrospective multicentric European survey about the outcome of laparoscopic partial nephrectomy in infants and children with duplex kidneys.
  
  
  METHODS
  The data of fifty-two children underwent laparoscopic partial nephrectomy (42 upper-pole nephrectomies and 10 lower-pole nephrectomies) in six European centers of Pediatric Surgery, were collected and analyzed. Median age at surgery was 5.1 years (range 6 months-9.7 years). There were 32 girls and 20 boys. In 37 patients, the left side was affected and in 15 patients the right side. For the right side, 4 trocars were used and for the left side 3/4 trocars. Special hemostatic devices were used for dissection and parenchymal section in all centers. We assessed intraoperative and postoperative morbidity.
  
  
  RESULTS
  Median length of surgery was 166.2 min (70-215 min). No conversion to open surgery nor intraoperative bleeding was reported. Mean hospitalization was 3.5 days. We recorded 10/52 complications (4 urinomas, 2 recurrent UTIs, 4 prolonged urinary leakage), all managed conservatively. Reoperation rate was 0%. No loss of renal function on the residual kidney moiety was recorded in all operated patients.
  
  
  CONCLUSIONS
  Laparoscopic partial nephrectomy remains a technically challenging procedure performed only in pediatric centers with high experience in minimally invasive surgery. Although the median operative time was higher than 2 h, we recorded no conversions in our series. The complication rate remains high (10/52-19.2%). All were II grade complications according to Clavien-Dindo classification and were treated conservatively without the need of other surgical procedures.
authors: Department of Translational Medical Sciences, Federico II University of Naples, Via Pansini 5, 80131, Naples, Italy. ciroespo@unina.it.
authors: Ciro
authors: C
authors: Esposito
authors: Department of Pediatric Surgery, Centre Hospitalier Universitaire, Hopital Nord, Saint-Étienne, France.
authors: Francois
authors: F
authors: Varlet
authors: Department of Pediatric Surgery, Wroclaw University, Wroclaw, Poland.
authors: Dariusz
authors: D
authors: Patkowski
authors: Department of Pediatric Surgery, University of Padua, Padua, Italy.
authors: Marco
authors: M
authors: Castagnetti
authors: Department of Translational Medical Sciences, Federico II University of Naples, Via Pansini 5, 80131, Naples, Italy.
authors: Maria
authors: M
authors: Escolino
authors: Department of Pediatric Surgery, Maria Sklodowska Curie Hospital for Children, Bucharest, Romania.
authors: Isabela Magdalena
authors: IM
authors: Draghici
authors: Department of Translational Medical Sciences, Federico II University of Naples, Via Pansini 5, 80131, Naples, Italy.
authors: Alessandro
authors: A
authors: Settimi
authors: Department of Translational Medical Sciences, Federico II University of Naples, Via Pansini 5, 80131, Naples, Italy.
authors: Antonio
authors: A
authors: Savanelli
authors: Department of Pediatric Surgery, Medical University of Graz, Graz, Austria.
authors: Holger
authors: H
authors: Till
mesh_terms: D002648:Child; D002675:Child, Preschool; D061887:Conversion to Open Surgery / Q000706:statistics & numerical data; D005060:Europe; D005260:Female; D006801:Humans; D007223:Infant; D007668:Kidney / Q000002:abnormalities* / Q000601:surgery; D007674:Kidney Diseases / Q000601:surgery*; D010535:Laparoscopy / Q000379:methods*; D007902:Length of Stay; D008297:Male; D009392:Nephrectomy / Q000379:methods*; D061646:Operative Time; D011183:Postoperative Complications / Q000209:etiology; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D013043:Specialties, Surgical; D011795:Surveys and Questionnaires
keywords: Children; Heminephrectomy; Laparoscopy; Partial nephrectomy