Ciro Esposito1, Maria Escolino2, Go Miyano3, Paolo Caione4, Fabio Chiarenza5, Giovanna Riccipetitoni6, Atsuyuki Yamataka3, Antonio Savanelli2, Alessandro Settimi2, Francois Varlet7, Dariusz Patkowski8, Mariapina Cerulo2, Marco Castagnetti9, Holger Till10, Rosaria Marotta11, Angela La Manna11, Jean-Stephane Valla12. 1. Department of Translational Medical Sciences, "Federico II" University of Naples, Via Pansini 5, 80131, Naples, Italy. ciroespo@unina.it. 2. Department of Translational Medical Sciences, "Federico II" University of Naples, Via Pansini 5, 80131, Naples, Italy. 3. Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine, Tokyo, Japan. 4. Department of Pediatric Urology, Bambino Gesù Hospital, Rome, Italy. 5. Department of Pediatric Surgery, San Bortolo Hospital, Vicenza, Italy. 6. Department of Pediatric Surgery, Buzzi Hospital, Milan, Italy. 7. Department of Pediatric Surgery, Centre Hospitalier Universitaire, Hopital Nord, Saint-Étienne, France. 8. Department of Pediatric Surgery, Wroclaw University, Wroclaw, Poland. 9. Department of Pediatric Surgery, University of Padua, Padua, Italy. 10. Department of Pediatric Surgery, Medical University of Graz, Graz, Austria. 11. Department of Pediatrics, Second University of Naples, Naples, Italy. 12. Department of Pediatric Surgery, CHU Lenval, Nice, France.
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.
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.
Authors: Martin Marszalek; Thomas Chromecki; Badereddin Mohamad Al-Ali; Herbert Meixl; Stephan Madersbacher; Klaus Jeschke; Karl Pummer; Richard Zigeuner Journal: Urology Date: 2011-01 Impact factor: 2.649
Authors: C Esposito; M Iaquinto; M Escolino; A Farina; A La Manna; A Savanelli; A Settimi; A Di Mezza Journal: Minerva Urol Nefrol Date: 2014-06 Impact factor: 3.720
Authors: Maria Escolino; Lorenzo Masieri; Jean-Stephane Valla; Pedro Josè Lopez; Baran Tokar; Imran Mushtaq; Ciro Esposito Journal: World J Urol Date: 2018-12-05 Impact factor: 4.226