title: A comparison between laparoscopic and retroperitoneoscopic approach for partial nephrectomy in children with duplex kidney: a multicentric survey.
abstract: OBJECTIVE
  To compare the outcome of laparoscopic and retroperitoneoscopic approach for partial nephrectomy in infants and children with duplex kidneys.
  
  
  METHODS
  Data of 102 patients underwent partial nephrectomy in a 5-year period using MIS procedures were analyzed. Fifty-two children underwent laparoscopic partial nephrectomy (LPN), and 50 children underwent retroperitoneoscopic partial nephrectomy (RPN). Median age at surgery was 4.2 years. Statistical analysis was performed using χ (2) test and Student's t test.
  
  
  RESULTS
  The overall complications rate was significantly higher after RPN (15/50, 30 %) than after LPN (10/52, 19 %) [χ (2) = 0.05]. In LPN group, complications [4 urinomas, 2 symptomatic refluxing distal ureteral stumps (RDUS) and 4 urinary leakages] were conservatively managed. In RPN group, complications (6 urinomas, 8 RDUS, 1 opening of remaining calyxes) required a re-operation in 2 patients. In both groups no conversion to open surgery was reported. Operative time (LPN:166.2 min vs RPN: 255 min; p < 0.001) and hospitalization (LPN: 3.5 days vs RPN: 4.1 days; p < 0.001) were significantly shorter in LPN group. No postoperative loss of renal function was reported in both groups.
  
  
  CONCLUSIONS
  Our results demonstrate that RPN remains a technically demanding procedure with a significantly higher complications and re-operation rate compared to LPN. In addition, length of surgery and hospitalization were significantly shorter after LPN compared to RPN. LPN seems to be a faster, safer and technically easier procedure to perform in children compared to RPN due to a larger operative space and the possibility to perform a complete ureterectomy in refluxing systems.
authors.affiliation: Department of Translational Medical Sciences, "Federico II" University of Naples, Via Pansini 5, 80131, Naples, Italy. ciroespo@unina.it.
authors.forename: Ciro
authors.initials: C
authors.lastname: Esposito
authors.affiliation: Department of Translational Medical Sciences, "Federico II" University of Naples, Via Pansini 5, 80131, Naples, Italy.
authors.forename: Maria
authors.initials: M
authors.lastname: Escolino
authors.affiliation: 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: Department of Pediatric Urology, Bambino Gesù Hospital, Rome, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Caione
authors.affiliation: Department of Pediatric Surgery, San Bortolo Hospital, Vicenza, Italy.
authors.forename: Fabio
authors.initials: F
authors.lastname: Chiarenza
authors.affiliation: Department of Pediatric Surgery, Buzzi Hospital, Milan, Italy.
authors.forename: Giovanna
authors.initials: G
authors.lastname: Riccipetitoni
authors.affiliation: 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: Department of Translational Medical Sciences, "Federico II" University of Naples, Via Pansini 5, 80131, Naples, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Savanelli
authors.affiliation: Department of Translational Medical Sciences, "Federico II" University of Naples, Via Pansini 5, 80131, Naples, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Settimi
authors.affiliation: Department of Pediatric Surgery, Centre Hospitalier Universitaire, Hopital Nord, Saint-Étienne, France.
authors.forename: Francois
authors.initials: F
authors.lastname: Varlet
authors.affiliation: Department of Pediatric Surgery, Wroclaw University, Wroclaw, Poland.
authors.forename: Dariusz
authors.initials: D
authors.lastname: Patkowski
authors.affiliation: Department of Translational Medical Sciences, "Federico II" University of Naples, Via Pansini 5, 80131, Naples, Italy.
authors.forename: Mariapina
authors.initials: M
authors.lastname: Cerulo
authors.affiliation: Department of Pediatric Surgery, University of Padua, Padua, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Castagnetti
authors.affiliation: Department of Pediatric Surgery, Medical University of Graz, Graz, Austria.
authors.forename: Holger
authors.initials: H
authors.lastname: Till
authors.affiliation: Department of Pediatrics, Second University of Naples, Naples, Italy.
authors.forename: Rosaria
authors.initials: R
authors.lastname: Marotta
authors.affiliation: Department of Pediatrics, Second University of Naples, Naples, Italy.
authors.forename: Angela
authors.initials: A
authors.lastname: La Manna
authors.affiliation: 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; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D007223:Infant; D007668:Kidney / Q000002:abnormalities* / Q000601:surgery*; D010535:Laparoscopy; D008297:Male; D009392:Nephrectomy / Q000379:methods*; D012187:Retroperitoneal Space; D012189:Retrospective Studies
keywords: Children; Complications; Duplex kidney; Partial nephrectomy