Retroperitoneoscopic nephrectomy/heminephrectomy in children planned, performed, and managed by supervised senior pediatric surgical trainees

Abstract

Introduction: Retroperitoneoscopic nephrectomy (R-neph) is still not generally favored by pediatric surgeons for various reasons, including lack of experience of retroperitoneal anatomy compared with pediatric urologists, concern about long operative times, and related complications.

Materials and methods: We compared nephrectomies/heminephrectomies planned, performed, and managed by five senior pediatric surgical trainees (SPST) under the supervision of a board-certified pediatric surgeon (BCPS) (A.Y.) using four-trocar retroperitoneoscopy (R-neph) (n=11) with conventional open nephrectomy and heminephrectomy (O-neph) (n=20) performed by 4 BCPS.

Results: O-neph comprised 14 nephrectomies and 6 upper pole nephrectomies; R-neph comprised 9 total nephrectomies and 2 upper pole nephrectomies. Mean age and mean weight at nephrectomy were not statistically different. Mean operating time (MOT) was 137 (range, 85-290) minutes in O-neph versus 197 (116-341) minutes in R-neph. MOT for the first 5 R-neph cases was 249 minutes versus 153 minutes for the last 6 cases. Mean blood loss was 17 (range, 1-55) mL in O-neph versus 10.3 (2-40) mL in R-neph. One R-neph case required conversion to O-neph. There were no transfusions and no intraoperative complications. Two partial heminephrectomy patients (one O-neph and one R-neph) developed transient urinoma postoperatively that resolved conservatively. Mean duration of postoperative bed rest was 1.0 day in O-neph versus 0.6 days in R-neph. Differences in mean postoperative fentanyl requirement (O-neph, 21.5 [10-40] μg/kg; R-neph, 4.1 [0-20] μg/kg) and duration of nonsteroidal anti-inflammatory suppository usage (O-neph, 2.3 [0-5] days; R-neph, 0.9 [0-2] days) were significant (both P<.05). Full oral feeding was resumed after a mean of 1.6 (1-2) days in O neph and 1.2 (1-2) days in R-neph.

Conclusions: R-neph was safely performed by SPST, and results were comparable to those with O-neph performed by BCPS.