title: Retroperitoneoscopic Heminephrectomy in Duplex Kidney in Infants and Children: Results of a Multicentric Survey.
abstract: OBJECTIVE
  Retroperitoneoscopic partial nephrectomy (RPN) in children is considered a complex technique with limited diffusion among pediatric surgeons and urologists. We aimed to report the outcome of this technique in infants and children with duplex kidney in a 5-year retrospective multicentric international survey.
  
  
  METHODS
  Data on 50 children who underwent RPN (41 upper-pole nephrectomies and 9 lower-pole nephrectomies) were retrospectively collected in this six-institution survey. Median age at surgery was 3.3 years. There were 35 girls and 15 boys. The left side was affected in 28 patients, versus the right side in 22 patients. We assessed intraoperative and postoperative morbidity. Follow-up (median, 2.5 years; range, 12 months-5 years) was based on clinical controls and echo color Doppler renal ultrasound scans.
  
  
  RESULTS
  Median duration of surgery was 255 minutes. Surgery was always performed with the patient in a lateral position. Special hemostatic devices were used for dissection and parenchymal section in all centers. Three patients from two centers (6%) required conversion to open surgery. We recorded seven complications (six peritoneal perforations, one opening of the remaining calyxes) in the 50 cases. Re-operation rate was 0%. Average length of hospital stay was 4.1 days.
  
  
  CONCLUSIONS
  Our survey shows that RPN remains a challenging procedure with a long learning curve, performed only in pediatric centers with huge experience in this field. In our survey operative time was longer than 4 hours. The complication rate remains high (7/50, or 14%), with complications classified as Grade II according to the Clavien-Dindo classification. They did not require further surgery, but they were associated with a prolonged hospital stay.
authors.affiliation: 1 Department of Translational Medical Sciences, "Federico II" University of Naples , Naples, Italy .
authors.forename: Ciro
authors.initials: C
authors.lastname: Esposito
authors.affiliation: 2 Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine , Tokyo, Japan .
authors.forename: Go
authors.initials: G
authors.lastname: Miyano
authors.affiliation: 3 Department of Pediatric Urology, Bambino Gesù Hospital , Rome, Italy .
authors.forename: Paolo
authors.initials: P
authors.lastname: Caione
authors.affiliation: 1 Department of Translational Medical Sciences, "Federico II" University of Naples , Naples, Italy .
authors.forename: Maria
authors.initials: M
authors.lastname: Escolino
authors.affiliation: 4 Department of Pediatric Surgery, San Bortolo Hospital , Vicenza, Italy .
authors.forename: Fabio
authors.initials: F
authors.lastname: Chiarenza
authors.affiliation: 5 Department of Pediatric Surgery, Buzzi Hospital , Milan, Italy .
authors.forename: Giovanna
authors.initials: G
authors.lastname: Riccipetitoni
authors.affiliation: 2 Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine , Tokyo, Japan .
authors.forename: Atsuyuki
authors.initials: A
authors.lastname: Yamataka
authors.affiliation: 1 Department of Translational Medical Sciences, "Federico II" University of Naples , Naples, Italy .
authors.forename: Mariapina
authors.initials: M
authors.lastname: Cerulo
authors.affiliation: 1 Department of Translational Medical Sciences, "Federico II" University of Naples , Naples, Italy .
authors.forename: Antonio
authors.initials: A
authors.lastname: Savanelli
authors.affiliation: 1 Department of Translational Medical Sciences, "Federico II" University of Naples , Naples, Italy .
authors.forename: Alessandro
authors.initials: A
authors.lastname: Settimi
authors.affiliation: 6 Department of Pediatric Surgery, CHU Lenval , Nice, France .
authors.forename: Jean-Stephane
authors.initials: JS
authors.lastname: Valla
mesh_terms: D002648:Child; D002675:Child, Preschool; D061887:Conversion to Open Surgery; D005260:Female; D006801:Humans; D007223:Infant; D007668:Kidney / Q000002:abnormalities* / Q000000981:diagnostic imaging / Q000601:surgery*; D010535:Laparoscopy / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D007902:Length of Stay; D008297:Male; D009392:Nephrectomy / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D061646:Operative Time; D010537:Peritoneum / Q000293:injuries; D012187:Retroperitoneal Space; D012189:Retrospective Studies; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D018615:Ultrasonography, Doppler, Color