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Extraperitoneal repair using modified single-port mini-nephroscopy for pediatric hydrocele: surgical outcomes in 65
Qianliang Wang1, Qingling Liu2
1Department of Urology, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China.
Insights
A modified single-port nephroscopy technique effectively treats pediatric communicating hydrocele. This minimally invasive approach offers rapid recovery and an excellent safety profile, making it a promising first-line surgical option.
Area of Science:
- Pediatric Surgery
- Urology
- Minimally Invasive Surgery
Background:
- Communicating hydrocele is a common condition in male infants.
- Traditional surgical approaches may involve open procedures with longer recovery times.
Purpose of the Study:
- To introduce and evaluate a modified single-port Mini-Nephroscopy technique for pediatric hydrocele treatment.
- To assess the safety and efficacy of this novel surgical approach.
Main Methods:
- A prospective study enrolled 65 male children (1.5-8 years) with unilateral communicating hydrocele.
- High ligation of the patent processus vaginalis was performed using a single-port nephroscope via an umbilical incision.
- Outcomes included testicular volume and resistance index (RI) assessed by scrotal ultrasonography at 1 and 6 months.
Main Results:
- The technique was successful in all 65 patients, with no conversion to open surgery.
- Mean operative time was 8-10 minutes, with all patients discharged within 24 hours.
- No recurrence, testicular atrophy, or other complications were observed during 3-18 months of follow-up.
Conclusions:
- Single-port nephroscopic high ligation is a highly effective treatment for pediatric communicating hydrocele.
- The technique offers minimal invasiveness, high efficiency, and rapid recovery.
- It presents a safe and promising first-line surgical option for this condition.
Objective:
The purpose of the study is to introduce our experience of a modified single-port Mini-Nephroscopy technique for the treatment of pediatric hydrocele.
Methods:
In this prospective study, 65 male children (age range: 1.5-8 years) with unilateral communicating hydrocele were enrolled between June 2019 and June 2022. The surgical procedure consisted of high ligation of the patent processus vaginalis performed extraperitoneally using a modified single-port nephroscope introduced through a single umbilical incision, facilitated by custom suture-guiding instruments. The primary outcome measures included testicular volume and testicular artery resistance index (RI), which were evaluated via scrotal ultrasonography preoperatively and at scheduled follow-ups of 1 and 6 months.
Results:
The novel technique was successfully employed in all 65 patients without conversion to open surgery. The mean operative time was remarkably brief (8-10 min), facilitating a 24-hour discharge for all children. Postoperative pain was well-controlled, with mean VAS scores decreasing from 2.1 ± 0.82.1 ± 0.8 at 6 h to 1.2 ± 0.51.2 ± 0.5 at 24 h, indicating only mild and transient discomfort. With a follow-up of 3-18 months, no instances of recurrence, testicular atrophy, or other complications (e.g., knot reactions, iatrogenic ascent) were observed.
Conclusion:
Single-port nephroscopic high ligation holds significant promise for pediatric communicating hydrocele, offering a compelling combination of minimal invasiveness, high operative efficiency, rapid recovery, and an excellent safety profile. These results strongly endorse its consideration as a first-line surgical treatment for this condition.