Twenty-year experience with laparoscopic and retroperitoneoscopic nephrectomy in children: considerations and details of technique.
BACKGROUND
Nephrectomy is probably the most common urological indication for minimally invasive surgery (MIS) in children. The authors reported their experience in laparoscopic and retroperitoneoscopic nephrectomy analyzing their 20 years of experience in this procedure.


METHODS
In a 20-year period (1995-2015), the authors performed 149 nephrectomies in children using MIS (87 left, 62 right). One hundred and one nephrectomies were performed using laparoscopy (LN) and 48 using retroperitoneoscopy (RN). Patients included 90 girls and 59 boys (average age 5.7 years). All the removed kidneys were nonfunctioning because of benign diseases: VUR (84), UPJO (38), MKDK (20), xanthogranulomatosis pyelonephritis (4), nephropathy causing uncontrollable hypertension (2) and nephrolithiasis (1).


RESULTS
We had no conversion in laparoscopy. As for RN, we had 2 conversions to laparoscopy at the beginning of experience due to peritoneal opening. Operative time varied from 30 to 130 min in laparoscopy (average 47 min) and from 60 to 150 min (average 78 min) in retroperitoneoscopy. We recorded 8 complications (5.3 %): 3 small bleedings (2 RN, 1 LN) during dissection, 2 peritoneal perforations during RN requiring conversion in LN, 1 abdominal abscess in case of xanthogranulomatosis pyelonephritis after LN requiring a redo surgery to drain the abscess, 1 instrumentation failure (LN) and 1 refluxing ureteral stump after RN requiring a redo surgery to remove it.


CONCLUSIONS
LN is easier and faster to perform compared to RN. Complication rate was higher after RN compared to LN. In case of xanthogranulomatous pyelonephritis or other kidney infections or in case of previous renal surgery, retroperitoneoscopy is contraindicated. In case of VUR, LN is preferable to RN because it is fundamental to remove all the ureter. On the basis of our 20-year experience, we clearly prefer to perform nephrectomy using laparoscopy rather than retroperitoneoscopy leaving the indication to adopt RN only for the rare cases of MKDK.
Department of Translational Medical Sciences, Federico II University of Naples, Via Pansini 5, 80131, Naples, Italy. ciroespo@unina.it.
Ciro
C
Esposito
Department of Translational Medical Sciences, Federico II University of Naples, Via Pansini 5, 80131, Naples, Italy.
Maria
M
Escolino
Department of General Laparoscopic and Robotic Surgery, Monaldi Hospital, Naples, Italy.
Francesco
F
Corcione
Department of Pediatric Surgery, Maria Sklodowska Curie Hospital for Children, Bucharest, Romania.
Isabela Magdalena
IM
Draghici
Department of Translational Medical Sciences, Federico II University of Naples, Via Pansini 5, 80131, Naples, Italy.
Antonio
A
Savanelli
Department of Pediatric Urology, University of Padua, Padua, Italy.
Marco
M
Castagnetti
Department of Translational Medical Sciences, Federico II University of Naples, Via Pansini 5, 80131, Naples, Italy.
Francesco
F
Turrà
Department of Translational Medical Sciences, Federico II University of Naples, Via Pansini 5, 80131, Naples, Italy.
Mariapina
M
Cerulo
Department of Translational Medical Sciences, Federico II University of Naples, Via Pansini 5, 80131, Naples, Italy.
Alessandra
A
Farina
Department of Translational Medical Sciences, Federico II University of Naples, Via Pansini 5, 80131, Naples, Italy.
Alessandro
A
Settimi
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007674:Kidney Diseases / Q000175:diagnosis / Q000601:surgery*; D010535:Laparoscopy / Q000379:methods; D008297:Male; D009392:Nephrectomy / Q000379:methods; D061646:Operative Time; D012189:Retrospective Studies; D016896:Treatment Outcome
Children; Complications; Laparoscopy; Nephrectomy; Retroperitoneoscopy