Initial experience with laparoendoscopic single-site nephrectomy and nephroureterectomy in children

Area of Science:

• Pediatric Urology
• Minimally Invasive Surgery
• Surgical Oncology

Background:

• Pediatric nephrectomy and nephroureterectomy are ablative procedures for conditions like recurrent pyelonephritis and ectopic ureters.
• Traditional laparoscopic surgery offers benefits over open surgery but can still leave multiple scars.
• Laparoendoscopic single-site surgery (LESS) aims to further minimize surgical invasiveness and improve cosmetic outcomes.

Purpose of the Study:

• To evaluate the clinical utility and safety of laparoendoscopic single-site surgery (LESS) for nephrectomy and nephroureterectomy in pediatric patients.
• To assess the feasibility of performing these procedures through a single umbilical incision.
• To analyze outcomes including operative time, blood loss, complications, and recovery.

Main Methods:

• A prospective analysis of 6 consecutive pediatric cases undergoing LESS nephrectomy or nephroureterectomy by a single surgeon.
• Utilized a homemade port inserted through an umbilical incision for transperitoneal laparoscopic procedures.
• Employed standard and articulating laparoscopic instruments for the surgeries.

Main Results:

• Six procedures (4 nephrectomies, 2 nephroureterectomies) were successfully completed without intraoperative or postoperative complications.
• Median operative time was 112 minutes, with a median blood loss of 0 mL.
• Patients experienced minimal pain, managed with oral ibuprofen, and were discharged on postoperative day 2. Umbilical incision length decreased with surgeon experience.

Conclusions:

• Pediatric LESS nephrectomy and nephroureterectomy are safe and feasible, achieving excellent outcomes with a single, small incision.
• LESS demonstrates potential as a primary therapeutic option for pediatric ablative renal procedures.
• Experienced surgeons can effectively implement LESS, offering improved cosmesis and potentially faster recovery.