Overview
Laparoscopic Nephrectomy
Is a procedure for removing a non-functioning kidney. A laparoscope camera is inserted through a small umbilical opening and instruments are placed through tiny openings along the abdominal wall. The kidney is removed through the umbilical opening, avoiding a large, visible scar. Because the procedure requires no cutting of muscle tissue, discomfort is minimal and most patients go home the same day.
Laparoscopic nephrectomy is a procedure for removing a non-functioning kidney. A laparoscopic camera is inserted through a small umbilical opening and instruments are placed through tiny openings along the abdominal wall. The kidney is removed through the umbilical opening, avoiding a large visible incision. Major advances in laparoscopic surgery have allowed for less invasive surgery in the realm of urology with the benefits of decreased post-operative discomfort and healing time as well as improved cosmetic results. Initially, laparoscopy had limited diagnostic and therapeutic uses. With the advent of automatic clip appliers, stapling devices, impermeable organ removal bags, and morcellating devices, the scope of procedures that can be performed laparoscopically has been broadened substantially.
In urology, such advances have allowed for laparoscopic varicocelectomies, bladder augmentations, urinary diversions, ureterolysis, adrenalectomies, nephrectomies, and nephro-ureterectomies. We now have performed over 50 laparoscopic nephrectomies on children at our center. Our director Dr. Dix Poppas has performed all the operations.
Some of the indications for nephrectomy have included large painful, multicystic dysplastic kidneys, poorly controlled renovascular hypertension, and a non-functioning kidney secondary to severe vesicoureteral reflux. Other children treated with this procedure have presented with urinary tract infections in the setting of non-functioning kidneys secondary to congenital UPJ obstructions. In one of these children (a 1 year old girl), a horseshoe kidney was discovered with a non-functioning right kidney secondary to UPJ obstruction.
Methods
A retrospective review was conducted of all pediatric patients undergoing a transperitoneal LN or LNU. Five of these patients had giant hydronephrosis in a nonfunctioning kidney. Because of chronic infection and the massive nature of hydronephrosis, the system was internally decompressed with an end-hole stent. Partial decompression provided space in the abdomen for adequate visualization while maintaining enough turgidity to facilitate dissection.
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