Laparoscopic partial nephrectomy for the treatment of large cystic nephroma in children.

UNLABELLED: Abstract

Background

Cystic nephroma (CN) is a rare benign renal neoplasm. The differential diagnosis of cystic partially differentiated nephroblastoma is only possible with pathological findings. Therefore, surgical resection is necessary to diagnose suspected CN lesions. Because CN is usually well demarcated and has a good prognosis, partial nephrectomy is recommended for its treatment. However, to our knowledge, laparoscopic treatment of CN has not been reported. We describe 2 cases of large CNs successfully treated: Case 1 was a 9-month-old boy with a lower polar mass in the right kidney, which occupied two-thirds of the kidney, and Case 2 was a 9-month-old boy with an upper polar mass in the left kidney, which occupied three-fourths of the kidney.

MATERIALS AND

METHODS

Using the transperitoneal approach, the lesion was detected by a laparoscopic ultrasound probe, and vessels in the affected region were dissected. After the renal artery was clamped with bulldog clips, the parenchyma of the affected region was divided with an ultrasonically activated scalpel. The partly cut pelvis was closed by suturing, and the resected stump was coated with hemostatic agents and covered with the pediculate peritoneum.

RESULTS

The lesion was not exposed during surgery, and the microscopic features were consistent with CN in both cases. Residual renal function was good, and no residual tumor was found in both cases for over a year.

CONCLUSIONS

Laparoscopic partial nephrectomy is a feasible approach to treat large CNs. When it is difficult to close the resection stump by parenchymal suturing, covering the stump with hemostatic agents and pediculate peritoneum is feasible.