Laparoscopic renal surgery in infants and children: is it a feasible and safe procedure for all pediatric age groups?

• Published in: International Brazilian journal of urology Vol. 34; no. 6; pp. 739 - 748
• Main Authors: Denes, Francisco T, Tavares, Alessandro, Monteiro, Edison D S, de Bessa, Jr, Jose, Giron, Amilcar M, Queiroz Filho, Frederico A, Srougi, Miguel
• Format: Journal Article
• Language: English
• Published: Brazil Sociedade Brasileira de Urologia 01-12-2008
• Subjects: Adolescent; Age Factors; Child; Child, Preschool; complications; Feasibility Studies; Female; Humans; Infant; Infant, Newborn; Intraoperative Complications; Kidney Diseases - surgery; laparoscopy; Laparoscopy - adverse effects; Laparoscopy - methods; Male; pediatrics; Postoperative Complications; renal surgery; results; Time Factors; Treatment Outcome
• ISSN: 1677-5538; 1677-6119; 1677-5538
• DOI: 10.1590/s1677-55382008000600009

Although laparoscopy is considered the mainstay for most renal procedures in adults, its role in the pediatric population is still controversial, especially for smaller children. We reviewed our experience in pediatric renal laparoscopic surgery in three pediatric age groups in an attempt to identify if age has an impact on feasibility and surgical outcomes.
From November 1995 to May 2006, 144 pediatric laparoscopic renal procedures were performed at our institution. The charts of these patients were reviewed for demographic data, urologic pathology and surgical procedure, as well as perioperative complications and post-operative outcomes. The findings were stratified into 3 groups, according to patient age (A: < 1 year, B: 1 to 5 years and C: 6-18 years).
Median age of the patients was 4.2 years (42 days - 18 years). We performed 54 nephrectomies, 33 nephroureterectomies, 19 upper pole nephrectomies, 11 radical nephrectomies, 22 pyeloplasties and 4 miscellaneous procedures. The 3 age groups were comparable in terms of the procedures performed. Conversion rates were 0%, 1.4% and 1.9% for groups A, B and C, respectively (p = 0.72). Incidence of perioperative complications was 5%, 8.2% and 7.8% for age groups A to C, respectively (p = 0.88).
Most renal procedures can be performed safely by laparoscopy in the pediatric population, with excellent aesthetic and functional outcomes. The morbidity related to the procedure was minimal irrespective of the age group.