Retroperitoneoscopic partial nephrectomy in children: a multicentric international comparative study between lateral versus prone approach

Maria Escolino, Giovanna Riccipetitoni, Atsuyuki Yamataka, Imran Mushtaq, Go Miyano, Paolo Caione, Fabio Chiarenza, Peter Borzi, Ciro Esposito

Research output: Contribution to journalArticle

Abstract

BACKGROUND: Very limited informations are currently available about the best approach to perform retroperitoneoscopic surgery. This multicentric international study aimed to compare the outcome of lateral versus prone approach for retroperitoneoscopic partial nephrectomy (RPN) in children.

METHODS: The records of 164 patients underwent RPN in 7 international centers of pediatric surgery over the last 5 years were retrospectively reviewed. Sixty-one patients (42 girls and 19 boys, average age 3.8 years) were operated using lateral approach (G1), whereas 103 patients (66 girls and 37 boys, average age 3.0 years) underwent prone RPN (G2). The two groups were compared in regard to operative time, postoperative outcome, postoperative complications, and re-operations.

RESULTS: The average operative time was significantly shorter in G2 (99 min) compared to G1 (160 min) (p = 0.001). Only 2 lateral RPN required conversion to open surgery. There was no significant difference between the two groups as for intraoperative complications (G1:2/61, 3.3%; G2:6/103, 5.8%; p = 0.48), postoperative complications (G1:9/61, 14.7%; G2:17/103, 16.5%; p = 0.80), and re-operations (G1:2/61, 3.3%; G2:4/103, 3.8%; p = 0.85). Regarding postoperative complications, the incidence of symptomatic residual distal ureteric stumps (RDUS) was significantly higher in G2 (7/103, 6.8%) compared to G1 (1/61, 1.6%) (p = 0.001). Most re-operations (4/6, 66.6%) were performed to remove a RDUS .

CONCLUSIONS: Both lateral and prone approach are feasible and reasonably safe to perform RPN in children but the superiority of one approach over another is not still confirmed. Although prone technique resulted faster compared to lateral approach, the choice of the technique remains dependent on the surgeon's personal preference and experience. Our results would suggest that the lateral approach should be preferred to the prone technique when a longer ureterectomy is required, for example in cases of vesico-ureteral reflux into the affected kidney moiety, in order to avoid to leave a long ureteric stump that could become symptomatic and require a re-intervention.

Original languageEnglish
JournalSurgical Endoscopy
DOIs
Publication statusE-pub ahead of print - Jul 13 2018

Fingerprint

Nephrectomy
Operative Time
Conversion to Open Surgery
Vesico-Ureteral Reflux
Intraoperative Complications
Pediatrics
Kidney
Incidence

Cite this

Retroperitoneoscopic partial nephrectomy in children : a multicentric international comparative study between lateral versus prone approach. / Escolino, Maria; Riccipetitoni, Giovanna; Yamataka, Atsuyuki; Mushtaq, Imran; Miyano, Go; Caione, Paolo; Chiarenza, Fabio; Borzi, Peter; Esposito, Ciro.

In: Surgical Endoscopy, 13.07.2018.

Research output: Contribution to journalArticle

Escolino, Maria ; Riccipetitoni, Giovanna ; Yamataka, Atsuyuki ; Mushtaq, Imran ; Miyano, Go ; Caione, Paolo ; Chiarenza, Fabio ; Borzi, Peter ; Esposito, Ciro. / Retroperitoneoscopic partial nephrectomy in children : a multicentric international comparative study between lateral versus prone approach. In: Surgical Endoscopy. 2018.
@article{a4a7055d91fe4149be1f12c83623f920,
title = "Retroperitoneoscopic partial nephrectomy in children: a multicentric international comparative study between lateral versus prone approach",
abstract = "BACKGROUND: Very limited informations are currently available about the best approach to perform retroperitoneoscopic surgery. This multicentric international study aimed to compare the outcome of lateral versus prone approach for retroperitoneoscopic partial nephrectomy (RPN) in children.METHODS: The records of 164 patients underwent RPN in 7 international centers of pediatric surgery over the last 5 years were retrospectively reviewed. Sixty-one patients (42 girls and 19 boys, average age 3.8 years) were operated using lateral approach (G1), whereas 103 patients (66 girls and 37 boys, average age 3.0 years) underwent prone RPN (G2). The two groups were compared in regard to operative time, postoperative outcome, postoperative complications, and re-operations.RESULTS: The average operative time was significantly shorter in G2 (99 min) compared to G1 (160 min) (p = 0.001). Only 2 lateral RPN required conversion to open surgery. There was no significant difference between the two groups as for intraoperative complications (G1:2/61, 3.3{\%}; G2:6/103, 5.8{\%}; p = 0.48), postoperative complications (G1:9/61, 14.7{\%}; G2:17/103, 16.5{\%}; p = 0.80), and re-operations (G1:2/61, 3.3{\%}; G2:4/103, 3.8{\%}; p = 0.85). Regarding postoperative complications, the incidence of symptomatic residual distal ureteric stumps (RDUS) was significantly higher in G2 (7/103, 6.8{\%}) compared to G1 (1/61, 1.6{\%}) (p = 0.001). Most re-operations (4/6, 66.6{\%}) were performed to remove a RDUS .CONCLUSIONS: Both lateral and prone approach are feasible and reasonably safe to perform RPN in children but the superiority of one approach over another is not still confirmed. Although prone technique resulted faster compared to lateral approach, the choice of the technique remains dependent on the surgeon's personal preference and experience. Our results would suggest that the lateral approach should be preferred to the prone technique when a longer ureterectomy is required, for example in cases of vesico-ureteral reflux into the affected kidney moiety, in order to avoid to leave a long ureteric stump that could become symptomatic and require a re-intervention.",
author = "Maria Escolino and Giovanna Riccipetitoni and Atsuyuki Yamataka and Imran Mushtaq and Go Miyano and Paolo Caione and Fabio Chiarenza and Peter Borzi and Ciro Esposito",
year = "2018",
month = "7",
day = "13",
doi = "10.1007/s00464-018-6349-z",
language = "English",
journal = "Surgical Endoscopy",
issn = "0930-2794",
publisher = "Springer New York",

}

TY - JOUR

T1 - Retroperitoneoscopic partial nephrectomy in children

T2 - a multicentric international comparative study between lateral versus prone approach

AU - Escolino, Maria

AU - Riccipetitoni, Giovanna

AU - Yamataka, Atsuyuki

AU - Mushtaq, Imran

AU - Miyano, Go

AU - Caione, Paolo

AU - Chiarenza, Fabio

AU - Borzi, Peter

AU - Esposito, Ciro

PY - 2018/7/13

Y1 - 2018/7/13

N2 - BACKGROUND: Very limited informations are currently available about the best approach to perform retroperitoneoscopic surgery. This multicentric international study aimed to compare the outcome of lateral versus prone approach for retroperitoneoscopic partial nephrectomy (RPN) in children.METHODS: The records of 164 patients underwent RPN in 7 international centers of pediatric surgery over the last 5 years were retrospectively reviewed. Sixty-one patients (42 girls and 19 boys, average age 3.8 years) were operated using lateral approach (G1), whereas 103 patients (66 girls and 37 boys, average age 3.0 years) underwent prone RPN (G2). The two groups were compared in regard to operative time, postoperative outcome, postoperative complications, and re-operations.RESULTS: The average operative time was significantly shorter in G2 (99 min) compared to G1 (160 min) (p = 0.001). Only 2 lateral RPN required conversion to open surgery. There was no significant difference between the two groups as for intraoperative complications (G1:2/61, 3.3%; G2:6/103, 5.8%; p = 0.48), postoperative complications (G1:9/61, 14.7%; G2:17/103, 16.5%; p = 0.80), and re-operations (G1:2/61, 3.3%; G2:4/103, 3.8%; p = 0.85). Regarding postoperative complications, the incidence of symptomatic residual distal ureteric stumps (RDUS) was significantly higher in G2 (7/103, 6.8%) compared to G1 (1/61, 1.6%) (p = 0.001). Most re-operations (4/6, 66.6%) were performed to remove a RDUS .CONCLUSIONS: Both lateral and prone approach are feasible and reasonably safe to perform RPN in children but the superiority of one approach over another is not still confirmed. Although prone technique resulted faster compared to lateral approach, the choice of the technique remains dependent on the surgeon's personal preference and experience. Our results would suggest that the lateral approach should be preferred to the prone technique when a longer ureterectomy is required, for example in cases of vesico-ureteral reflux into the affected kidney moiety, in order to avoid to leave a long ureteric stump that could become symptomatic and require a re-intervention.

AB - BACKGROUND: Very limited informations are currently available about the best approach to perform retroperitoneoscopic surgery. This multicentric international study aimed to compare the outcome of lateral versus prone approach for retroperitoneoscopic partial nephrectomy (RPN) in children.METHODS: The records of 164 patients underwent RPN in 7 international centers of pediatric surgery over the last 5 years were retrospectively reviewed. Sixty-one patients (42 girls and 19 boys, average age 3.8 years) were operated using lateral approach (G1), whereas 103 patients (66 girls and 37 boys, average age 3.0 years) underwent prone RPN (G2). The two groups were compared in regard to operative time, postoperative outcome, postoperative complications, and re-operations.RESULTS: The average operative time was significantly shorter in G2 (99 min) compared to G1 (160 min) (p = 0.001). Only 2 lateral RPN required conversion to open surgery. There was no significant difference between the two groups as for intraoperative complications (G1:2/61, 3.3%; G2:6/103, 5.8%; p = 0.48), postoperative complications (G1:9/61, 14.7%; G2:17/103, 16.5%; p = 0.80), and re-operations (G1:2/61, 3.3%; G2:4/103, 3.8%; p = 0.85). Regarding postoperative complications, the incidence of symptomatic residual distal ureteric stumps (RDUS) was significantly higher in G2 (7/103, 6.8%) compared to G1 (1/61, 1.6%) (p = 0.001). Most re-operations (4/6, 66.6%) were performed to remove a RDUS .CONCLUSIONS: Both lateral and prone approach are feasible and reasonably safe to perform RPN in children but the superiority of one approach over another is not still confirmed. Although prone technique resulted faster compared to lateral approach, the choice of the technique remains dependent on the surgeon's personal preference and experience. Our results would suggest that the lateral approach should be preferred to the prone technique when a longer ureterectomy is required, for example in cases of vesico-ureteral reflux into the affected kidney moiety, in order to avoid to leave a long ureteric stump that could become symptomatic and require a re-intervention.

U2 - 10.1007/s00464-018-6349-z

DO - 10.1007/s00464-018-6349-z

M3 - Article

C2 - 30006841

JO - Surgical Endoscopy

JF - Surgical Endoscopy

SN - 0930-2794

ER -