Heminephrectomy in a duplex kidney (two pelvicalyceal systems) is a procedure used for the complicated clinical course. The most common indications for surgery in children are
- recurrent urinary tract infections (UTIs),
- ureterocelles with a hypo or a functioning moiety and
- ectopic ureter causing incontinence in girls. Laparoscopic partial/heminephrectomy is technically demanding and requires a learning curve
Pre-operatively diagnostic methods like abdominal ultrasonography, voiding cystourethrography (VCUG), and kidney scintigraphy may be done in all patients to confirm the diagnosis before venturing for hemi-nephrectomy. Some patients may additionally be supplemented with a computed tomography (CT) urogram.
We use transperitoneal access using the laparoscopic technique. The patient is placed in an oblique position, with elevation of the operated side. A 5 mm umbilical trocar is inserted into the peritoneal cavity. In addition, two 5 mm trocars are inserted in the hypochondriac and suprapubic region. After incision of the parietal peritoneum, both ureters are identified. After dissection of the ureter of the resected moiety it is traced to the kidney pole and the identification of polar vessels. The vessels supplying the affected kidney pole are either clipped or closed with Bi-clamp or Ligasure bipolar forceps and cut. After the demarcation line is made visible on the kidney, the moiety of the kidney is removed by a diathermy Bi-clamp or Ligasure. The resected moiety of the kidney with the ureter is removed through the umbilicus. A drain is left in the kidney area through the suprapubic port. After removal of the trocars, single sutures were placed on the fascia and the skin, followed by a sterile dressing.