Laparoscopic transperitoneal partial nephrectomy in children under 2 years old: a single-centre experience

To report our experience with laparoscopic transperitoneal (TP) heminephrectomy for duplicated pyeloureteral systems in children under 2 years old.

We retrospectively reviewed the intraoperative evolution and patient outcome of 10 laparoscopic partial ureteronephrectomies (7 upper and 3 lower pole nephrectomies) using a TP approach, performed over 4 years. Mean age at surgery was 9.1 months (range 3.5-20.4), with seven children younger than 1 year. Average follow up based on clinical examinations and renal ultrasounds was 13.9 months (range 1.2-38.5).

The average operative time was 123 min (range 90-195). There was no need for conversion and no intraoperative complications. Mean postoperative hospital stay was 2.9 days. A perirenal collection with spontaneous regression occurred in one case. The main postoperative complication consisted of a diminution in renal function with pyelic dilation in a 4-month-old child, due to inadequate positioning of the remaining moiety. This child remains asymptomatic 3 years after surgery.

We recommend a TP approach for laparoscopic heminephrectomy due to the improved vascular exposure and control, diminished need for renal mobilization, and greater working space that can be obtained, especially in toddlers with a higher morbidity rate caused by the lack of retroperitoneal space.