Laparoscopic Heminephrectomy

Laparoscopy  is the current method of choice  to perform heminephroureterectomy  in children. This can be obtained through a transperitoneal (TP) or a retroperitoneal approach.

Duplex ureter is one of the most frequent causes of heminephrectomy in children. In Duplex system the upper moiety is frequently obstructed, poor functioning, and can become symptomatic due to urinary tract infection (UTI), flank pain or stone formation.

The standard surgical treatment of a non-functioning symptomatic renal moiety is ipsilateral heminephrectomy. Minimally invasive surgery in paediatric patients has made considerable progress in the past decade, so it became the current approach to perform heminephroureterectomy (HN) in children. This can be obtained through a transperitoneal (TP) or a retroperitoneal (RP) approach.

Surgical Procedure:

  1. Patients is placed in a 45° lateral position under general anaesthesia.

 

  1. A Hasson trocar is inserted through the umbilicus and pneumoperitoneum induced by the same mean. Under laparoscopy intra-abdominal organs are examined, and two 5-mm trocars were inserted on the anterior axillary line of the upper and lower quadrant.

 

  1. The kidney is exposed by mobilising the colon medially from the retroperitoneum. The ureter draining the affected pole is identified and separated from the healthy ureter. Vessels branching to the pole are separated from the healthy branch, ligated, and cut using clips or LigaSure.

 

  1. The Upper Pole renal parenchyma is transected using LigaSure or electrocautery hook. Bleeding of the transacted surface was controlled using    The ureteral stumps is sectioned and tied with an endoloop as low as possible, whether they are refluxing or not.

Post Operative:

The bladder catheter and the drain are usually removed on the 1st and 3rd post op day, respectively.

All heminephrectomy specimen are subjected to histological examination.

Ultrasound is done, 3 months after surgery and repeated after a year.  A DTPA scan is done 6 months after surgery.

The laparoscopic approach offers a good working space with an ideal ergonomics, a good view of renal vessels and ureter, a short hospital stay and allows a very low isolation of the ureteral stump..

Suggested Reading:

  1. Marte A, Papparella A, Pintozzi L. Laparoscopic upper pole heminephroureterectomy in children: Seven-year experience. Afr J Paediatr Surg [serial online] 2015 [cited 2019 Sep 8];12:227-31.
2.     Caracas A, Aydogdu O, Atesci YZ. Unilateral complete ureteral duplication with distal ureteral stone: A rare entity. Can Urol Assoc J. 2013;7(7-8):E511-2.

 

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