Abstract
Objective
To review and compare 4 different surgical approaches for partial nephrectomy of a
nonfunctioning moiety in children with upper urinary tract duplication anomalies.
Materials and methods
A retrospective review of all pediatric patients who underwent open partial nephrectomy
(OPN), laparoscopic partial nephrectomy (LPN), robotic partial nephrectomy (RPN),
or laparoendoscopic single site partial nephrectomy (LESS-PN) for the treatment of
a nonfunctioning moiety in a duplicated collecting system at 2 medical centers between
2007 and 2017. Patient demographics, perioperative data, surgical techniques, complications,
and results were compared.
Results
A total of 59 pediatric patients underwent partial nephrectomy for an upper urinary
tract duplication anomaly during a 10-year period: 24 OPN, 7 LPN, 18 RPN, and 10 LESS-PN.
Median age was 16 months (interquartile range 9-49.7). Median weight was 10.7 Kg (interquartile
range 8.8-16.4). Median estimated blood loss was comparable between all minimally
invasive approaches, but significantly increased in the open approach. OPN required
more narcotics (0.554 mg Morphine equivalent/Kg/day, range 0.03-6.13) and Acetaminophen
(72.12 mg/Kg/day, range 0-209.06) than all other groups in the study. Median operating
time in OPN (154.5 minutes, range 108-413) and LESS-PN (140 minutes, range 65-245)
were found to be significantly shorter in comparison to LPN (190 minutes, range 159-355),
and RPN (256 minutes, range 163-458); (P = .03, .005, .02, and .005).
Conclusion
Minimally invasive approaches (LPN, RPN, and LESS-PN) for partial nephrectomy in upper
urinary tract duplication anomalies may be associated with decreased postoperative
analgesia requirements, shorter hospital stay, less blood loss, and less use of drains
in comparison to the open approach, while demonstrating efficacy and safety.
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Article info
Publication history
Published online: November 23, 2018
Accepted:
November 20,
2018
Received:
September 26,
2018
Footnotes
Financial Disclosure: The authors state that no competing financial interests exist.
Identification
Copyright
© 2018 Elsevier Inc. All rights reserved.
