A comparison between laparoscopic and retroperitoneoscopic approach for partial nephrectomy in children with duplex kidney: a multicentric survey

Ciro Esposito, Maria Escolino, Go Miyano, Paolo Caione, Fabio Chiarenza, Giovanna Riccipetitoni, Atsuyuki Yamataka, Antonio Savanelli, Alessandro Settimi, Francois Varlet, Dariusz Patkowski, Mariapina Cerulo, Marco Castagnetti, Holger Till, Rosaria Marotta, Angela Manna, Jean Stephane Valla

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Abstract

PURPOSE: To compare the outcome of laparoscopic and retroperitoneoscopic approach for partial nephrectomy in infants and children with duplex kidneys.

METHODS: Data of 102 patients underwent partial nephrectomy in a 5-year period using MIS procedures were analyzed. Fifty-two children underwent laparoscopic partial nephrectomy (LPN), and 50 children underwent retroperitoneoscopic partial nephrectomy (RPN). Median age at surgery was 4.2 years. Statistical analysis was performed using χ (2) test and Student's t test.

RESULTS: The overall complications rate was significantly higher after RPN (15/50, 30 %) than after LPN (10/52, 19 %) [χ (2) = 0.05]. In LPN group, complications [4 urinomas, 2 symptomatic refluxing distal ureteral stumps (RDUS) and 4 urinary leakages] were conservatively managed. In RPN group, complications (6 urinomas, 8 RDUS, 1 opening of remaining calyxes) required a re-operation in 2 patients. In both groups no conversion to open surgery was reported. Operative time (LPN:166.2 min vs RPN: 255 min; p < 0.001) and hospitalization (LPN: 3.5 days vs RPN: 4.1 days; p < 0.001) were significantly shorter in LPN group. No postoperative loss of renal function was reported in both groups.

CONCLUSIONS: Our results demonstrate that RPN remains a technically demanding procedure with a significantly higher complications and re-operation rate compared to LPN. In addition, length of surgery and hospitalization were significantly shorter after LPN compared to RPN. LPN seems to be a faster, safer and technically easier procedure to perform in children compared to RPN due to a larger operative space and the possibility to perform a complete ureterectomy in refluxing systems.

Original languageEnglish
Pages (from-to)939-48
Number of pages10
JournalWorld Journal of Urology
Volume34
Issue number7
DOIs
Publication statusPublished - Jul 2016

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  • Journal Article

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    Esposito, C., Escolino, M., Miyano, G., Caione, P., Chiarenza, F., Riccipetitoni, G., Yamataka, A., Savanelli, A., Settimi, A., Varlet, F., Patkowski, D., Cerulo, M., Castagnetti, M., Till, H., Marotta, R., Manna, A., & Valla, J. S. (2016). A comparison between laparoscopic and retroperitoneoscopic approach for partial nephrectomy in children with duplex kidney: a multicentric survey. World Journal of Urology, 34(7), 939-48. https://doi.org/10.1007/s00345-015-1728-8