Pediatric retroperitoneal laparoscopic partial nephrectomy: comparison with an age matched cohort of open surgery

We assessed the clinical usefulness of laparoscopic retroperitoneal partial nephrectomy (LRPN) in children by comparing an age matched cohort of pediatric patients undergoing open partial nephrectomy (OPN) to those undergoing LRPN for safety, efficacy, operative time, blood loss, inpatient narcotic use and length of hospitalization.

A retrospective case-control study was performed of 1 group undergoing LRPN (treatment arm) and 1 undergoing OPN (controls) between 1997 and 2003. The 14 patients in each group were matched by age (mean 1.9 years in LRPN group vs 2.2 years in OPN group, p = 0.98) and gender.

All patients had duplication anomalies. Mean operative time was 194 minutes in the LRPN group and 193 minutes in the OPN group (p = 0.83). The single complication in the LRPN group was a urinoma that did not require intervention. There were no complications in OPN group. LRPN patients had a mean hospitalization of 1.7 days compared to 4.7 days in OPN patients (p = 0.001). Intraoperative narcotic requirements were higher in the LRPN group (0.59 vs 0.22 mg/kg, p = 0.04). Postoperative narcotic requirements were significantly less in the LRPN group (0.44 vs 1.53 mg/kg, p = 0.04). Similar findings were noted in a subanalysis of patients younger than 2 years. All patients had documented postoperative ipsilateral renal growth. Mean followups in the treatment and control groups were 26 and 25 months, respectively.

Retroperitoneal laparoscopic partial nephrectomy in small children was shown to be safe and effective. It had equivalent operative times, and decreased postoperative narcotics and hospitalization relative to the open approach, and, therefore, is a potentially advantageous technique.