Further experience with laparoscopic nephrectomy for Wilms' tumour after chemotherapy
Ricardo J Duarte1, Francisco T Dénes, Lilian M Cristofani
1Department of Urology, University of São Paulo Medical School, São Paulo, Brazil. ricjordao@uol.com.br
Objective:
To report the results of laparoscopic nephrectomy for unilateral Wilms' tumour in children treated with chemotherapy before surgery.
Patients And Methods:
Eight children with unilateral nonmetastatic Wilms' tumour included in the International Society of Pediatric Oncology 2001 protocol were treated with vincristine/actinomycin D and then had laparoscopic nephrectomy and lymph-node sampling. A Veress needle puncture was made and a four-trocar transperitoneal approach was used in all cases. The tumour was extracted with no morcellation through a Pfannenstiel incision.
Results:
All eight tumours were completely removed, with lymph node samples; intraoperative bleeding was minimal (50 mL). There were no complications after surgery and patients were discharged after 2-3 days. No recurrences of disease, port-site implantation or long-term complications were detected.
Conclusions:
Laparoscopic nephrectomy for unilateral Wilms' tumour is feasible in children after chemotherapy; it is safe and allows the complete surgical approach required for treating this tumour. Although the patients had a good long-term follow-up, more patients are needed to compare the results of laparoscopic techniques with open surgery.
