Transcript laparoscopy in children – review of our experience

LAPAROSCOPY IN CHILDREN
– REVIEW OF OUR
EXPERIENCE
Hemraj, RAMESH BABU S
Pediatric urology unit
SRI RAMACHANDRA MEDICAL COLLEGE AND RESEARCH
INSTITUTE
CHENNAI
INTRODUCTION

Laparoscopy has become the mainstay of treatment for many
conditions in adult urology.

Diagnostic laparoscopy was done 30 years ago in pediatric urology
for diagnosing non palpable testes1.

Era of therapeutic laparoscopy began with introduction of clipping
for 1st stage Fowler-Stephens operation in 19912 and laparoscopic
orchidopexy was performed in 19943.


1. Cortesi N, Ferrari P, Zambarda E, et al: Diagnosis of bilateral abdominal cryptorchidism by laparoscopy. Endoscopy 1976;8:33.
2. Bloom DA: Two-step orchiopexy with pelviscopic clip ligation of the spermatic vessels. J Urol 1991;145:1030–1033.
3. Jordan GH: Will laparoscopic orchiopexy replace open surgery for the nonpalpable undescended testis? [editorial; comment]. J Urol
1997;158:1956.
Introduction

Development of laparoscopy in pediatric urology was
slower when compared to adults.

With availability of expertise and equipments, more
centers have started using laparoscopic approach for
management of pediatric urological problems.
MATERIALS AND METHODS

All the children who underwent laparoscopy for various
paediatric urological problems from July 2006 to June
2008 were included in the study.
General principles

Open Hassan’s technique was used for umbilical port in
all the cases

Transperitoneal approach was adapted in all the cases

Ports
– 10 mm and 5 mm ports were used
– Two lateral ports and one umbilical port were used
– Whenever indicated a fourth port was used

Intra abdominal pressure
– Was always kept low at about 8 – 10 mmHg
Port placement
0 10mm
05mm
010mm
05mm
Right nephrectomy
05mm
010mm
05mm
010mm
Left nephrectomy
Procedures
Lap
 Lap
 Lap
 Lap
 Lap
 Lap

Total
orchidopexy
Ureterolysis
assisted nephrectomy
nephrectomy
assisted pyeloplasty
pyeloplasty
6
1
3
7
3
1
21
RESULTS

The mean operating time was 3 hours ( 2 – 3.5 hours )

The operating time was higher in the initial cases (3.5
hours)

With the learning curve, the current operating time has
come down further
Results

Conversion rate
– 3/21 procedures (14%)
– 1 nephrectomy; 2 pyeloplasty

Intra operative problems (during early stages)
– Bowel distension (avoid nitrous oxide, Pre op enema)
– Hyper carbia (using low pressures, intermittent deflation)

Duration of hospital stay
– Mean duration 4.5 days (3-8 days)
– Main reason to stay was to establish feeds, IV antibiotics etc
Paediatric Laparoscopy Vs Adult

Advantages
– Well defined tissue planes
– Thin abdominal wall
– Smaller vessels, amenable to clips / diathermy

Limitations
– Limited space, Ports clash
– Size of the instruments
– Complications such as bowel injury
DISCUSSION

Laparoscopy offers reduced hospital stay, reduced
complications and superior cosmetic results in children

More complex procedures can be performed with ease

Multiple problems can be tackled with planning ports

With experience, the operating time is significantly
reduced nearing to that of a open procedure.
THANK YOU