CODE: 17 - Laparoscopy in pediatric urology
Article published in Urologia Polska 2006/59/Suplement 1.

authors

Piotr Gastoł, Kinga Kowalczyk, Jerzy Czyż, Małgorzata Baka-Ostrowska

Klinika Urologii Dziecięcej, Instytut Centrum Zdrowia Dziecka

summary

Introduction. Progress in minimal invasive surgery and miniaturization of the endoscopic equipments allow for wide use of laparoscopic techniques in pediatric urology.

Objectives. We want to show our experience with laparoscopic procedures in pediatric urology.

Materials and methods. Between 1999-2005 175 laparoscopic procedures in children were performed. In 63 boys laparoscopic ligation of the varicocoele was done (Palomo procedure in 62 and in 1 artery sparing surgery m. Bernardi). In 35 boys because of the abdominal cryptorchidism, laparoscopy was performed. Gonadectomy was performed in 37 intersex children. Nephrectomy was done in 36 children (in 33 cases transperitoneally, and in 3 by flank retroperitoneal approach), and in 4 children simple renal cyst was excised (in all cases transperitoneally).

Results. There was no recurrence after laparoscopic varicocele ligation. In 7 boys hydrocoele was observed (3 of them were operated). Among 35 boys with abdominal cryptorchidism, in 5 hypoplastic testis was found, which was excised. In 27 blind-ending spermatic vessels with vas without testis was discovered (in 11 in abdomen, and in 16 entering internal ring). In 3 boys with good abdominal testis two stages Fowler-Stephens operation was used. After first-stage in 1 patient testis vanished and other two are waiting for second step. Among 37 intersex children after gonadectomy, in 5 gonadoblastoma in I stage was found. In 3 cases, among 40 kidney's laparoscopic procedures, we converted the procedure (in 2 because of technical reason, in 1 because of anesthesiology problems). One patient, in whom the procedure lasted for 6 hours, developed thrombophlebitis of the lower extremities. Average hospital stay was from 2 days (varicocoele, cryptorchidism, gonadectomy) to 5 days (nephrectomy). Healing of the wounds was without complications. In long term observation cosmetic results were very good.

Conclusions. 1. There is no abdominal complication after transperitoneal access. 2. Less operating trauma - shorter hospital stay. 3. Very good cosmetic results after laparoscopic procedures. 4. Laparoscopy is a future in many procedures in pediatric urology.