Single-incision laparoscopic nephroureterectomy in children of all age groups

Background/PurposeThe purpose of this study was to assess different surgical approaches for laparoendoscopic single-site nephroureterectomy according to weight groups.MethodsLESS nephroureterectomy was performed in 11 children. Indication for nephrectomy was a non-functioning kidney owing to vesicoureteral reflux or giant cystic dysplasia. Children below 10 kg body weight underwent LESS nephroureterectomy through an umbilical incision using one 5 mm and two 3 mm trocars (Manhattan technique). Patients above 10 kg were operated on using a metal multi-use single-site single port (X-Cone).ResultsMedian age at operation was 12 months (0.75-128), and median weight was 8.5 kg (3.1-67). Median operating time was 110 minutes (50–260). Eight children underwent LESS nephroureterectomy using the Manhattan-technique, and three patients were operated on with the X-Cone. All operations were carried out in a transperitoneal technique without using additional trocars. There were no complications. Recovery was uneventful in all children.ConclusionsLESS nephroureterectomy for pediatric patients can be done safely and efficiently, irrespective of age and weight. However, different surgical approaches have to be considered owing to the fact that single-site ports are not available for small children and infants. Both techniques will benefit from future development of instruments and trocars more suitable for small children. The question whether LESS provides even less trauma than in conventional laparoscopy remains doubtful.