Abstract
Purpose
Computer-assisted laparoscopic surgery (CALS) in children is increasingly used and has proven to be feasible and safe. However, its full potential remains unclear and clinical comparative studies hardly exist. The aim of this study was to prospectively evaluate our experience with CALS for performing retroperitoneal nephrectomies in children when compared with controls undergoing open surgery in terms of safety, operative time, blood loss, opoid requirements, the duration of hospital stay and complications.
Children and methods
Computer-assisted retroperitoneoscopic nephrectomy was undertaken in ten consecutive children, mean age at the time of surgery 6.4 (SD ± 4.5) years, and compared with a retrospectively collected control group of all other children, mean age 3.9 (SD ± 4.6) years, who underwent the same procedure by conventional open surgery between the years 2005 and 2009. The endpoint of the study was 1 month postoperatively.
Results
Nephrectomies were performed in all the children and no child was excluded from the study. There was no per-operative complication in any of the groups. The median (range) operative time was 202 (128–325) and 72 (44–160) min for the CALS and open group, respectively. The blood loss was minimal (<20 ml) for all the patients. The postoperative opoid requirements did not differ. The median (range) postoperative hospital stay was 1 (1–4) and 2 (1–7) days for the CALS and the open group, respectively. One complication in the form of an urinoma appeared 5 days after surgery in the CALS group.
Conclusion
Computer-assisted retroperitoneoscopic nephrectomy is a safe, feasible and effective procedure in children. Even though operative times are longer the patients benefit from the lower morbidity, improved cosmetics and shorter hospitalization associated with the minimally invasive approach.
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Acknowledgments
Gillian Sjödahl, Lexis English for Writers, Persikevägen 11, SE-223 55 Lund, Sweden, for linguistic revision of the manuscript. Håkan Lövkvist and Güner Nuray, Competence Centre for Clinical Research, Skåne University Hospital, SE-205 02 Malmö, Sweden, for statistical advice.
Conflict of interest
When performing this work, there were no external influences or conflicts of interest. None of the authors has received financial support of any kind from any of the manufacturers of the material used for the care of the reported patients.
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Anderberg, M., Kockum, C.C. & Arnbjörnsson, E. Paediatric computer-assisted retroperitoneoscopic nephrectomy compared with open surgery. Pediatr Surg Int 27, 761–767 (2011). https://doi.org/10.1007/s00383-011-2860-1
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DOI: https://doi.org/10.1007/s00383-011-2860-1