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Laparoscopic nephrectomy: advantages of technique in infants and newborns
Svetlana Ionouchene1, Nikolay Mikhaylov, Vladimir Novozhilov
1Research Center of Medical Ecology, East Siberian Scientific Center, Siberian Branch of Russian Academy of Medical Sciences, 16 Timiryasev Str., Irkutsk 664003, Russian Federation. ionouche@hotmail.com
Unlabelled:
In spite of the appearance of new instruments, equipment, and new surgical techniques, the amount of laparoscopic procedures in newborns and infants remains limited. Nevertheless, some advantages of the laparoscopic nephrectomy technique in infants, which we present in this article allow us to recommend this approach as the method of choice in some renal pathologies in infants and newborns.
Materials And Methods:
During the last 2 years of using laparoscopy, we removed 9 multicystic dysplastic kidneys. All babies were full term. The mean age was 5 weeks (range, 3-9) at the time of the procedures, and mean body weight was 4.130 g (range, 3.750-5.230 g).
Results:
Five of the 9 removed kidneys were located at the left side. The average size of removed kidneys was: length from 30 to 70 mm, width from 25 to 40 mm. During the procedures, we noted the following technical advantages in infants, in comparison with older children: Troacarless approaches for instruments are easy to do and for the exchange of instruments, if necessary We did not need more than three approaches at the same time Wide mobilization and back fixation of colon are not necessary Kidney mobilization is easy enough We did not need clip application, just coagulation of vessels Easy mobilization of the ureter without any additional peritoneum cutting Possibility of extraction of nonfragmented kidney The mean duration of the procedure was 47 + or - 8 minutes, including changing the babies' position. All babies needed postoperative analgesia just once, and all of them were discharged on the day after procedures. In all cases, we observed good aesthetic results.
Conclusions:
We believe that the laparoscopic approach should be considered if nephrectomy is indicated in newborns and infants less than 3 month of life. There are the advantages that simplify the surgical technique, reduce quantity of the necessary endoscopic instruments, and minimize surgical trauma and morbidity, thereby improving cosmetic results and reducing hospital stay in this age group.
