Is retroperitoneoscopy the gold standard for endoscopic nephrectomy in children on peritoneal dialysis?

Konrad Szymanski, Martin Bitzan, John Paul Capolicchio

Research output: Contribution to journalArticle

10 Citations (Scopus)

Abstract

Purpose: The literature on minimally invasive nephrectomy in adults and children on peritoneal dialysis is sparse. Case reports suggest that the transperitoneal approach is effective. We present our experience with retroperitoneoscopic nephrectomy in children on peritoneal dialysis. Materials and Methods: At 11 consecutive retroperitoneoscopic nephrectomies a total of 14 kidneys were removed from 10 children with a mean age of 12 years. We used a 3-port lateral retroperitoneoscopic nephrectomy technique with active trainee participation. Preoperative and postoperative biochemistry results within 3 months of surgery were compared with the Wilcoxon signed rank test. Results: Three bilateral synchronous, 1 bilateral staged and 6 unilateral retroperitoneoscopic nephrectomies were done. Mean operative time was 174 minutes for unilateral and 458 minutes for bilateral nephrectomy, including 1 simultaneous peritoneal dialysis insertion and 1 umbilical hernia repair. No open conversion, blood transfusion or postoperative surgical complication was noted. Peritoneal dialysis was initiated at a median of 9 hours postoperatively and dialysate volume was titrated to target within a median of 60 hours. One patient with a small peritoneotomy needed temporary hemodialysis despite intraoperative airtight repair. After surgery median serum albumin increased from 30.0 to 34.3 gm/l. Conclusions: Retroperitoneoscopic nephrectomy for end stage renal disease is a safe, effective technique that preserves peritoneal integrity in children who require immediate postoperative peritoneal dialysis. Avoiding post-nephrectomy hemodialysis decreases patient morbidity, preserving vessels for future vascular access. Compared to the literature on laparoscopy in this setting, retroperitoneoscopic nephrectomy can be considered the ideal approach for minimally invasive nephrectomy in patients on peritoneal dialysis.

Original languageEnglish (US)
Pages (from-to)1631-1636
Number of pages6
JournalJournal of Urology
Volume184
Issue number4 SUPPL.
DOIs
StatePublished - Oct 2010
Externally publishedYes

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Peritoneal Dialysis
Nephrectomy
Renal Dialysis
Umbilical Hernia
Herniorrhaphy
Dialysis Solutions
Operative Time
Nonparametric Statistics
Serum Albumin
Blood Transfusion
Biochemistry
Laparoscopy
Chronic Kidney Failure
Blood Vessels
Morbidity
Kidney

Keywords

  • kidney
  • kidney failure, chronic
  • laparoscopy
  • nephrectomy
  • peritoneal dialysis

ASJC Scopus subject areas

  • Urology
  • Medicine(all)

Cite this

Is retroperitoneoscopy the gold standard for endoscopic nephrectomy in children on peritoneal dialysis? / Szymanski, Konrad; Bitzan, Martin; Capolicchio, John Paul.

In: Journal of Urology, Vol. 184, No. 4 SUPPL., 10.2010, p. 1631-1636.

Research output: Contribution to journalArticle

Szymanski, Konrad ; Bitzan, Martin ; Capolicchio, John Paul. / Is retroperitoneoscopy the gold standard for endoscopic nephrectomy in children on peritoneal dialysis?. In: Journal of Urology. 2010 ; Vol. 184, No. 4 SUPPL. pp. 1631-1636.
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abstract = "Purpose: The literature on minimally invasive nephrectomy in adults and children on peritoneal dialysis is sparse. Case reports suggest that the transperitoneal approach is effective. We present our experience with retroperitoneoscopic nephrectomy in children on peritoneal dialysis. Materials and Methods: At 11 consecutive retroperitoneoscopic nephrectomies a total of 14 kidneys were removed from 10 children with a mean age of 12 years. We used a 3-port lateral retroperitoneoscopic nephrectomy technique with active trainee participation. Preoperative and postoperative biochemistry results within 3 months of surgery were compared with the Wilcoxon signed rank test. Results: Three bilateral synchronous, 1 bilateral staged and 6 unilateral retroperitoneoscopic nephrectomies were done. Mean operative time was 174 minutes for unilateral and 458 minutes for bilateral nephrectomy, including 1 simultaneous peritoneal dialysis insertion and 1 umbilical hernia repair. No open conversion, blood transfusion or postoperative surgical complication was noted. Peritoneal dialysis was initiated at a median of 9 hours postoperatively and dialysate volume was titrated to target within a median of 60 hours. One patient with a small peritoneotomy needed temporary hemodialysis despite intraoperative airtight repair. After surgery median serum albumin increased from 30.0 to 34.3 gm/l. Conclusions: Retroperitoneoscopic nephrectomy for end stage renal disease is a safe, effective technique that preserves peritoneal integrity in children who require immediate postoperative peritoneal dialysis. Avoiding post-nephrectomy hemodialysis decreases patient morbidity, preserving vessels for future vascular access. Compared to the literature on laparoscopy in this setting, retroperitoneoscopic nephrectomy can be considered the ideal approach for minimally invasive nephrectomy in patients on peritoneal dialysis.",
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