Transperitoneal laparoscopic nephrectomy in children

Over a 40-month period, 24 consecutive children (1-15 years) underwent laparoscopic nephrectomy. The indication for surgery was a poorly functioning kidney (<6% on DMSA isotope scanning) secondary to a variety of causes, with or without pain or infection. Four cannulas were used in each patient. The kidney was approached through a small incision in the upper paracolic gutter without mobilization of the colon. The procedure was successful in all but one child, who had conversion to open technique because of poor laparoscopic viewing. In 12 children who required nephroureterectomy, the distal ureter was approached by an open technique through either a small extension of the iliac fossa cannula site or a Pfannenstiel incision for combined bladder surgery. The average operating time for laparoscopy was 85 (range 40-160) minutes. The children undergoing nephrectomy or nephroureterectomy alone had an average hospital stay of 2 (range 1-4) days. There were no laparoscopic or surgical complications. Laparoscopy provides a safe and successful approach to pediatric nephrectomy. The technique combines well with an open approach to the distal ureter when nephroureterectomy is indicated.