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Surgical Endoscopy
Published in: Surgical Endoscopy 3/2019

01-03-2019

Retroperitoneoscopic partial nephrectomy in children: a multicentric international comparative study between lateral versus prone approach

Authors: Maria Escolino, Giovanna Riccipetitoni, Atsuyuki Yamataka, Imran Mushtaq, Go Miyano, Paolo Caione, Fabio Chiarenza, Peter Borzi, Ciro Esposito

Published in: Surgical Endoscopy | Issue 3/2019

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Abstract

Background

Very limited informations are currently available about the best approach to perform retroperitoneoscopic surgery. This multicentric international study aimed to compare the outcome of lateral versus prone approach for retroperitoneoscopic partial nephrectomy (RPN) in children.

Methods

The records of 164 patients underwent RPN in 7 international centers of pediatric surgery over the last 5 years were retrospectively reviewed. Sixty-one patients (42 girls and 19 boys, average age 3.8 years) were operated using lateral approach (G1), whereas 103 patients (66 girls and 37 boys, average age 3.0 years) underwent prone RPN (G2). The two groups were compared in regard to operative time, postoperative outcome, postoperative complications, and re-operations.

Results

The average operative time was significantly shorter in G2 (99 min) compared to G1 (160 min) (p = 0.001). Only 2 lateral RPN required conversion to open surgery. There was no significant difference between the two groups as for intraoperative complications (G1:2/61, 3.3%; G2:6/103, 5.8%; p = 0.48), postoperative complications (G1:9/61, 14.7%; G2:17/103, 16.5%; p = 0.80), and re-operations (G1:2/61, 3.3%; G2:4/103, 3.8%; p = 0.85). Regarding postoperative complications, the incidence of symptomatic residual distal ureteric stumps (RDUS) was significantly higher in G2 (7/103, 6.8%) compared to G1 (1/61, 1.6%) (p = 0.001). Most re-operations (4/6, 66.6%) were performed to remove a RDUS .

Conclusions

Both lateral and prone approach are feasible and reasonably safe to perform RPN in children but the superiority of one approach over another is not still confirmed. Although prone technique resulted faster compared to lateral approach, the choice of the technique remains dependent on the surgeon’s personal preference and experience. Our results would suggest that the lateral approach should be preferred to the prone technique when a longer ureterectomy is required, for example in cases of vesico-ureteral reflux into the affected kidney moiety, in order to avoid to leave a long ureteric stump that could become symptomatic and require a re-intervention.
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Metadata
Title
Retroperitoneoscopic partial nephrectomy in children: a multicentric international comparative study between lateral versus prone approach
Authors
Maria Escolino
Giovanna Riccipetitoni
Atsuyuki Yamataka
Imran Mushtaq
Go Miyano
Paolo Caione
Fabio Chiarenza
Peter Borzi
Ciro Esposito
Publication date
01-03-2019
Publisher
Springer US
Published in
Surgical Endoscopy / Issue 3/2019
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI
https://doi.org/10.1007/s00464-018-6349-z

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