Role of laparoscopic surgery in pediatric urology

In our clinic, laparoscopy was introduced in 1987 for the exploration of non-palpable testes and since 1991 it has also been applied with therapeutic aims. We present our experience with this minimally invasive technique in pediatric patients.

Between May 1987 and September 1996, 219 laparoscopic procedures were performed in children. All children received general anesthesia. Positioning of the patient on a rotatable and tiltable operating table is very important.

All laparoscopic interventions were well tolerated in children. The operative time for exploration of a nonpalpable testis ranged from 10 to 30 min, and for varix ligation from 15 to 30 min. In nephrectomy and nephroureterectomy cases 80-150 min were required. The excision of the urachal remnant and the drainage of lymphocele took between 30 and 70 min. No immediate postoperative complications were observed. Mobilization and oral intake were routinely carried out on the day of surgery. The children required little or no postoperative pain medication.

Laparoscopy has been found to be the most reliable diagnostic tool in evaluating nonpalpable testes within the pediatric population. This approach enables subsequent therapy of laparoscopic orchiectomy, primary laparoendoscopic orchidopexy, or laparoscopically assisted two-stage Fowler-Stephens maneuver. Laparoscopic varix ligation is a simple and highly effective treatment modality for the pubescent male with a symptomatic varicocele. To date, the recurrence rate is 1.8% based on 80 patients followed for over 1 year. Fenestration of lymphoceles following renal transplantation has been found to be as efficaciously treated with laparoscopy as with open surgery. Laparoscopic nephrectomy and/or nephroureterectomy are technically demanding procedures and should only be performed by an experienced laparoscopic surgical team to minimize the complication rate. At the present time, the intraoperative costs of laparoscopic surgery are greater than with open surgery due to the use of disposable instrumentation and longer operating room times. However, minimally invasive surgery continues to gain a greater and more important role in the field of pediatric urology.