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Endoscopic nephrectomy in children: is retro the way forward?
Jimmy P H Lam1, Gordon A MacKinlay, Fraser D Munro
1Department of Paediatric Surgery, Royal Hospital for Sick Children, Sciennes Road, Edinburgh EH9 1LF, United Kingdom.
Objective:
To determine the benefits of nephrectomy in children performed via a retroperitoneoscopic approach compared to the laparoscopic route.
Materials And Methods:
We reviewed all endoscopic nephrectomies performed at our institution from August 1998 to February 2003.
Results:
A total of 32 endoscopic nephrectomies were undertaken: 22 laparoscopic nephrectomies with 5 conversions to open surgery, and 10 retroperitoneoscopic. The main indication for surgery was poor function secondary to either reflux or obstructive nephropathy. Intraoperative heart rate changes were less marked in patients undergoing retroperitoneoscopic nephrectomy. The median operative time for retroperitoneoscopic nephrectomy was 65 minutes and 95 minutes for laparoscopy. Epidural analgesia was not required in successful endoscopic nephrectomies. The median postoperative morphine requirement in the retroperitoneoscopic group was 110mcg/kg compared to 280mcg/kg in the laparoscopic group. The majority of patients who had successful endoscopic nephrectomies were discharged to home within 2 days of surgery.
Conclusion:
Retroperitoneoscopic nephrectomy appears to be a safe technique in children, with reduced intraoperative physiological effects compared to the laparoscopic approach. Operative time was generally shorter than the laparoscopic approach and there appeared to be an additional benefit of reduced postoperative pain.
