laparoscopy in children – review of our experience
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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