ENDOUROLOGY & LAPAROSCOPY

Minimally invasive pediatric nephrectomy
Harrell WB, Snow BW
University of Utah Health Sciences Center, Division of Urology, Salt Lake City, Utah, USA, and Primary Children’s Medical Center, Division of Pediatric Urology, Salt Lake City, Utah, USA
Curr Opin Urol. 2005; 15: 277-281

• Purpose of Review: Since the first laparoscopic pediatric nephrectomy was performed in 1992, many articles have reported the feasibility of minimally invasive nephrectomy, heminephrectomy, and nephroureterectomy in children. This article reviews the literature related to minimally invasive nephrectomy, including robot-assisted surgery, and its complications published between November 2002 and November 2004.
• Recent Findings: The retroperitoneoscopic approach to nephrectomy and nephroureterectomy continues to prove successful in the pediatric population, although the transperitoneal approach is beneficial in combined upper and lower tract procedures. Initial reports on bilateral transperitoneal nephrectomy for nephrotic syndrome and laparoscopic nephrectomy for Wilms tumor are presented. Comparison studies between laparoscopic nephrectomy and open procedures are reviewed. Robot-assisted procedures are possible in children but little information is available on their pediatric use at the present time. Laparoscopy in children appears to have a similar complication rate to that in adults.
• Summary: More studies are needed to compare the outcomes of minimally invasive procedures with those of open procedures. Robot-assisted surgery offers promise but expense currently limits its use.
  
  
• Editorial Comment
  Since the first laparoscopic nephrectomy in a child was performed by Kavoussi and Koyle in 1992, many articles have demonstrated the feasibility of laparoscopic nephrectomy, heminephrectomy, and nephroureterectomy in children but this surgical technique remains controversial in the pediatric population. This review demonstrates the feasibility, differences between laparoscopic urological surgery in adults versus children, the possible future applications of laparoscopic anatomical knowledge to decrease intraoperative morbidity and superior cosmetic results of minimally invasive surgery.

Dr. Fernando J. Kim
Assistant Professor of Urology
University of Colorado Health Sciences Center
Denver, Colorado, USA