Korean J Urol.  2013 Aug;54(8):541-546. 10.4111/kju.2013.54.8.541.

Laparoendoscopic Single-Site Urologic Surgery in Children Less Than 5 Years of Age

• Ganpule A
• Sheladiya
• Mishra S
• Sabnis R
• Desai M

• KMID: 1840468
• DOI: http://doi.org/10.4111/kju.2013.54.8.541

Abstract

PURPOSE
We report our experience with laparoendoscopic single-site (LESS) urological procedures in children less than 5 years of age.
MATERIALS AND METHODS
Ten patients (11 procedures) underwent LESS through the umbilicus. Seven patients underwent nephrectomy and three patients underwent pyeloplasty (one simultaneous bilateral). R-port port (Advanced Surgical Concepts, Ireland) was used in nine cases, in one case, the Gelpoint access port (Applied Medical, Rancho Santa Margarita, CA, USA) was used. The Olympus Endoeye camera with coaxial light cable was used. The hilum was secured in all cases with Hem-o-Lok clips (Teleflex Medical, Research Triangle Park, NC, USA) except in one case in which an Endo GIA stapler (Covidien Surgical, Norwalk, CT, USA) was used.
RESULTS
All procedures were technically successful. Accessory port (3 mm) was used in 3 patients. Mean age in nephrectomized patients was 3.14+/-1.7 years, the mean operative room time (ORT) was 97.5+/-12.54 minutes. In the pyeloplasty group, mean ORT was 192+/-47.16 minutes and mean age was 2.43+/-2.3 years. Bilateral pyeloplasty was done in a 4-month-old infant. The ORT in this case was 180 minutes. A follow-up renogram done in the pyeloplasty patients (n=2) showed good drainage. Mean length of stay was 3.6 days (range, 3 to 6 days).The analgesic requirement was 23.86 mg (range, 12.5 to 50 mg) of diclofenac sodium.
CONCLUSIONS
LESS is technically feasible in patients as young as 4 months of age. It has the potential to offer better cosmesis. This needs to be proved in further comparative studies. Development of miniature instruments will further the growth of LESS in this age group.

Keyword

Laproscopy; Nephrectomy; Pyeloplasty

MeSH Terms

Child
Diclofenac
Drainage
Follow-Up Studies
Humans
Infant
Length of Stay
Light
Nephrectomy
Umbilicus
Diclofenac

Figure

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  FIG. 1 The steps of laparoendoscopic single-site nephrectomy mirror those of standard multiport laparoscopy. IVC, inferior vena cava.

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  FIG. 2 Specimen retrieval is possible through the same incision.

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  FIG. 3 The Triport access port was used in all laparoendoscopic single-site pyeloplasty. An anterior abdominal wall hitch stitch helps to avoid an extra port and instrument clashing.

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