One-trocar-assisted nephrectomy (OTAN): initial experience and codification of a technique

Area of Science:

• Pediatric Urology
• Minimally Invasive Surgery
• Nephrectomy Techniques

Background:

• Laparoscopic nephrectomy is a viable alternative to open surgery in children.
• A retroperitoneal approach is often preferred for nephroureterectomy in benign conditions.
• One trocar-assisted nephrectomy (OTAN) is proposed to minimize access-related complications.

Purpose of the Study:

• To evaluate the safety and efficacy of retroperitoneal one trocar-assisted nephrectomy (OTAN) in children with benign renal disease.
• To report the institutional experience with this minimally invasive technique.

Main Methods:

• A retrospective review of 27 retroperitoneal one trocar-assisted nephrectomies performed between 2003 and 2009.
• Indications included multicystic dysplastic kidney (MCDK), dysplastic kidney, and reflux nephropathy.
• Median patient age was 7.6 months.

Main Results:

• Median operative time was 60 minutes with no perioperative transfusions required.
• No major complications occurred; 14.8% conversion to open surgery due to small working space or difficult visualization.
• Median hospital stay was 2 days with excellent cosmetic outcomes and uneventful convalescence.

Conclusions:

• Retroperitoneal one trocar-assisted nephrectomy (OTAN) is a safe and effective treatment for pediatric benign renal disease.
• The procedure offers minimal morbidity, comparable operative times, and excellent cosmesis.
• Early discharge is facilitated due to reduced postoperative pain.