[Laparoscopy in pediatric urology].

OBJECTIVES

To establish urological pathologies in which video-assisted laparoscopy would be indicated as an alternative to conventional surgery.

METHODS

From 1995 to December 2000 we performed 106 urological laparoscopic procedures in 99 children six months to 16 years old (mean age of 7 years). The indications for laparoscopy were: a) Diagnostic indications in 60 patients (n)/65 procedures (p) including intrabdominal testis (n = 28, p = 33) and renal biopsy (n = 32, p = 32); b) Therapeutical indications in 33 patients (n)/34 procedures (p) consisted of varicocelectomy (n = 5, p = 7), orchiectomy (n = 1, p = 1), closure of patent processus vaginalis (n = 2, p = 4), retroperitoneoscopic nephrectomy (n = 16, p = 18), renal cyst excision (n = 2, p = 2), marsupialization of symptomatic giant lymphocele after renal transplantation (n = 2, p = 4), and c) Retroperitoneoscopic approach before open access in 6 patients/7 procedures.

RESULTS

The laparoscopic approach was effective in 100% and 94.2% of diagnostic and therapeutic procedures, respectively. Conversion to an open approach was required in two procedures because of peritoneal perforation during retroperitoneoscopic nephrectomy in one case and bleeding after retroperineoscopic renal biopsy in the other. Previous retroperitoneal surgery is not a contraindication for retroperitoneoscopy. There were no postoperative complications with intraoperative morbidity of 2.8%. Overall average hospital stay was 1.4 days.

CONCLUSIONS

Minimally invasive surgery plays an important role in management of pediatric urology patients. Nowadays, there are procedures in pediatric urology that can be considered established indications for laparoscopic or retroperitoneoscopic approaches.