Video bankSingle incision prone retroperitoneoscopic paediatric nephrectomy
Introduction
The first paediatric laparoendoscopic single-site (LESS) nephrectomy was reported in 2009; the operation was undertaken via the transperitoneal route [1]. We have previously described our early experience of single-incision nephrectomy via the retroperitoneal prone route using an advanced access platform (GelPOINT Mini – Advanced Medical, CA, USA) [2]. Here, we review our series to date and also present a detailed video demonstrating the technique.
Section snippets
Methods
In the prone position, the hips and the chest were elevated. A single transverse 2–2.5-cm incision was made at the midpoint on a line along the lateral border of erector spinae bound by the lower border of the 12th rib and the iliac crest. Posterior abdominal muscles were gently split and the deep lumbodorsal fascia incised. The retroperitoneum was entered and the inner ring of the Alexis retractor positioned deep to the lumbodorsal fascia; rolling in of the outer ring retracted the wound. Two
Results
Between July 2013 and March 2015, we used the single-incision retroperitoneoscopic prone approach to perform 10 nephrectomies in nine patients (4 male and 5 female). Nephrectomies were performed for multicystic dysplastic kidneys (n = 4), focal segmental glomerulosclerosis (n = 2), obstructive nephropathy (n = 3), and dysplasia (n = 1). Median age at nephrectomy was 10.9 years (range 2.7–15.9 years). Median kidney length was 7.5 cm (range 3.7–11.5 cm). The kidneys were either retrieved directly
Discussion
Since 2009, increasing numbers of publications reporting paediatric LESS nephrectomy have appeared in the medical literature. Given that the technique of LESS nephrectomy avoids multiple trocar sites, it allows further potential for improved cosmesis, decreased morbidity, and faster recovery than conventional laparoscopy.
Unique technical challenges of LESS have been described (limited triangulation, instrument clash, in-line camera angles, and a need for increased co-ordination with the
Conclusions
Single-incision retroperitoneal prone paediatric nephrectomy is feasible, safe, and provides excellent cosmesis.
Conflict of interest
None.
Funding
None.
Ethical approval
Ethical approval was not required for this educational video. Parental consent was obtained for filming of the procedure and educational use of the images obtained.
Acknowledgements
The authors would like to thank Mr Nick Geddes (Medical Photography) for his assistance in the production of this video.
References (4)
- et al.
Single incision retro-peritoneoscopic paediatric nephrectomy: early experience
J Pediatr Urol
(2014) - et al.
Single-incision laparoscopic nephroureterectomy in children of all age groups
J Pediatr Surg
(2013)
Cited by (5)
Laparoendoscopic single-site nephrectomy in children: Is it a good alternative to conventional laparoscopic approach?
2018, Journal of Pediatric UrologyCitation Excerpt :LESS pediatric nephrectomy was first described in 2009 by Johnson and colleagues [10]. However, LESS retroperitoneoscopic nephrectomy also has been performed in children with good results [11]. Despite availability of reticulating instruments in 5-mm, cost may be an obstacle to implementation of LESS surgery in pediatric patients [11].
Laparoendoscopic single-site surgery (LESS) for major urological procedures in the pediatric population: A systematic review
2016, International Journal of SurgeryCitation Excerpt :Postoperative hospital stay ranged from 0 to 12 days (weighted mean: 2.33 days from 102 patients) and postoperative complications were observed in 5 patients (2.87%); four Clavien-Dindo grade II (two cases of port site infection, one case of umbilical infection all treated with oral antibiotics in an outpatients basis and one case of supplemental analgesia) and one Clavien-Dindo grade III complication (persistent fever, anemia requiring transfusion and radiological evidence of retroperitoneal fluid collection drained percutaneously complicated by pseudomembranous colitis). In 19 patients (5 male and 14 female) aged 1.67–15.9 years, 20 nephrectomies were performed via the retroperitoneal route (Table 3) [31–33]. The size of incision ranged from 1.1 –to 2.5 cm.
Retroperitoneoscopic Nephrectomy in Pediatric Patients
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