title: Retroperitoneal and laparoscopic heminephrectomy in duplex kidney in infants and children.
abstract: BACKGROUND
  Two main techniques are adopted to perform partial nephrectomy in children: laparoscopy and retroperitoneoscopy. The aim of this paper is to review the larger multicentric experience recently published by our group to review indications, techniques and results of both approaches.
  
  
  METHODS
  Data of 102 patients underwent partial nephrectomy in a 5-year period using minimally invasive surgery (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 χ2test and Student'st-test.
  
  
  RESULTS
  The overall complications rate was significantly higher after RPN (15/50, 30%) than after LPN (10/52, 19%) (χ2=0.05). In LPN group, complications [4 urinomas, 2 symptomatic refluxing distal ureteral stump (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 minvs. RPN: 255 min; P<0.001) and hospitalization (LPN: 3.5 daysvs. 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
  MIS now represents the gold standard technique to perform partial nephrectomy in children with duplex kidney. 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: Pediatric Surgery Unit, Federico II University of Naples, Naples, Italy.
authors.forename: Ciro
authors.initials: C
authors.lastname: Esposito
authors.affiliation: Pediatric Surgery Unit, Federico II University of Naples, Naples, Italy.
authors.forename: Maria
authors.initials: M
authors.lastname: Escolino
authors.affiliation: Pediatric Urology Unit, University Hospital of Padova, Padua, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Castagnetti
authors.affiliation: Pediatric Surgery Unit, Federico II University of Naples, Naples, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Savanelli
authors.affiliation: Pediatric Nephrology Unit, Second University of Naples, Naples, Italy.
authors.forename: Angela
authors.initials: A
authors.lastname: La Manna
authors.affiliation: Pediatric Surgery Unit, Federico II University of Naples, Naples, Italy.
authors.forename: Alessandra
authors.initials: A
authors.lastname: Farina
authors.affiliation: Pediatric Surgery Unit, Federico II University of Naples, Naples, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Turrà
authors.affiliation: Pediatric Surgery Unit, Federico II University of Naples, Naples, Italy.
authors.forename: Agnese
authors.initials: A
authors.lastname: Roberti
authors.affiliation: Pediatric Surgery Unit, Federico II University of Naples, Naples, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Settimi
authors.affiliation: Pediatric Surgery Unit, St Etienne Hospital, St Etienne, France.
authors.forename: Francois
authors.initials: F
authors.lastname: Varlet
authors.affiliation: Graz Children Hospital, Graz, Austria.
authors.forename: Holger
authors.initials: H
authors.lastname: Till
authors.affiliation: Pediatric Surgery Unit, Lenval Hospital, Nice, France.
authors.forename: Jean Stephan
authors.initials: JS
authors.lastname: Valla
keywords: Partial nephrectomy; children; complications; duplex kidney