Feasibility and safety of laparoscopic ablative renal surgery in infants: comparative study with children

We evaluated the feasibility and safety of laparoscopic ablative renal surgery in infants and small children 10 kg or less compared to children weighing more than 10 kg.

A total of 86 cases were performed by a single surgeon who had mastered the learning curve. Subjects consisted of 25 patients 12 months or younger or weighing 10 kg or less at surgery (group A) and 61 patients older than 12 months and weighing more than 10 kg at surgery (group B). Operative and convalescence parameters, and intraoperative and postoperative complications were compared between the groups. Binary logistic regression analysis was used to estimate the association of baseline characteristics with complications.

All procedures were completed laparoscopically. There was no significant difference in operative and convalescence parameters, or overall intraoperative and postoperative complications between the 2 groups. Most intraoperative complications (10 of 13) were peritoneal tear during the retroperitoneal approach. Atelectasis was the most common postoperative complication (14 of 23 cases). Operative approach (retroperitoneal vs transperitoneal) was a significant determinant of intraoperative complications (OR 7.6, p = 0.005). Type of surgery (heminephrectomy or isthmectomy vs nephrectomy) was a significant determinant of postoperative complications (OR 5.2, p = 0.014).

Laparoscopic ablative renal surgery is safe and feasible even in infants and small children. Intraoperative and postoperative complications are associated with approach and type of surgery, respectively.