Early comparison of nephrectomy options in children (open, transperitoneal laparoscopic, laparo‐endoscopic single site (LESS), and robotic surgery)
Authors: Kim Philip H. , Patil Mukul B. , Kim Steve S. , Dorey Frederick , De Filippo Roger E. , Chang Andy Y. , Hardy Brian E. , Gill Inderbir S. , Desai Mihir M. , Koh Chester J. 
Published: August 2011

Study Type – Therapy (case series)

Level of Evidence 4

What's known on the subject? and What does the study add?

For pediatric patients with nonfunctioning or poorly‐functioning kidneys, laparoscopic nephrectomy has been shown to be a safe, viable option to traditional open surgery, with potential advantages of shorter hospital stays, decreased postoperative pain medication usage, and improved cosmesis.

Technological advances have expanded the surgical options for nephrectomy beyond traditional laparoscopy to robot‐assisted laparoscopy and, more recently, to laparo‐ endoscopic single‐site (LESS) surgery, which is also known as single incision laparoscopic surgery (SILS) or “belly‐button” surgery.

This study compares the perioperative parameters of three minimally invasive modalities for pediatric nephrectomy: traditional laparoscopic nephrectomy (LAP), robotic‐assisted laparoscopic nephrectomy (RALN), and laparo‐endoscopic single‐site nephrectomy (LESS), where these parameters are compared to those of a comparable series of patients undergoing traditional open nephrectomy (OPEN) during the same time period.

This study demonstrates that the minimally invasive modalities for nephrectomy in children, including LESS nephrectomy, are associated with shorter lengths of hospital stay and decreased postoperative pain medication usage when compared to open surgery, and where LESS nephrectomy is associated with similar surgical times, lengths of hospital stay, and postoperative pain medication usage as the other minimally invasive modalities (LAP and RALN).

OBJECTIVE

To compare the perioperative parameters of paediatric patients who underwent nephrectomy via laparo‐endoscopic single site (LESS) surgery (also known as single incision laparoscopic surgery or SILS) with those who underwent nephrectomy via conventional laparoscopy (LAP), robotic‐assisted laparoscopy (RALN), and open surgery (OPEN).

PATIENTS AND METHODS

The medical records of 69 paediatric patients at a single institution who underwent nephrectomies for non‐functioning kidneys in 72 renal units (39 OPEN, 11 LAP, 11 RALN and 11 LESS) were reviewed for patient demographics and perioperative clinical parameters.

RESULTS

The minimally invasive modalities in children, including LESS nephrectomy, were associated with shorter lengths of hospital stay (P < 0.001) and decreased postoperative pain medication usage (P < 0.001) than with open surgery.

Similar surgical times were noted with LESS and the other minimally invasive modalities (LAP and RALN) (P= 0.056). However, the minimally invasive modalities (LESS, LAP and RALN) were associated with slightly longer surgical times when compared with open surgery (P < 0.001), which may, in part, be secondary to learning curve factors.

No differences were noted among the minimally invasive modalities for postoperative pain medication usage (P= 0.354) and length of hospital stay (P= 0.86).

CONCLUSIONS

The minimally invasive modalities for nephrectomy in children, including LESS nephrectomy, are associated with shorter lengths of hospital stay and decreased postoperative pain medication use when compared with open surgery.

LESS nephrectomy in children is associated with similar surgical times, lengths of hospital stay and postoperative pain medication use as the other minimally invasive modalities (LAP and RALN).

Slightly longer surgical times are noted with the minimally invasive modalities, including LESS nephrectomy, when compared with open surgery, which may, in part, be secondary to learning curve factors.