- Email: [email protected]
537 Laparoendoscopic single-site surgery (LESS) for treatment of different urologic pathologies in pediatrics: Initial experience
537
Laparoendoscopic single-site surgery (LESS) for treatment of different urologic pathologies in pediatrics: Initial experience Eur Urol Suppl 2013;12;e537
Abdel-Karim A., Moussa A., Elmissery M., Abolfotoh A., Mahfouz W., Elsalmy S. Alexandria University, Dept. of Urology, Alexandria, Egypt INTRODUCTION & OBJECTIVES: Laparoendoscopic single-site surgery (LESS) has been increasingly reported as a new less invasive approach for treatment of various urologic pathologies in adults. However, the applications of LESS in the field of pediatric urology are still limited. In this study we present our initial experience with LESS as an option for treatment of some pediatric urologic pathologies. MATERIAL & METHODS: This is a retrospective study that included 12 pediatric patients with a mean age 5.2 ± 2.7 years. Four patients had unilateral undescended testes, 3 with bilateral undecended testes, 2 with left and one with bilateral varicocele, one with right multicystic dysplastic kidney and one with left ureteropelvic junction obstruction (UPJO). Ports used were R-port (10 patients) and Covieden port (2 patients) and the ports were inserted through the umbilicus. We used pre-bent (with R-port), articulating (with Covieden port) as well as straight instruments. In patient with left UPJO, LESS dismembered pyeloplasty was done through hand free suturing technique using 4/0 vicryl sutures. RESULTS: In all patients there was no conversion to conventional laparoscopy or open surgery. We did not add any extraport in any of the patients. Mean operative time 110 ± 45 minutes. Mean blood loss was 40 ±30 c.c. No intraoperative or postoperative complications were reported. Mean hospital stay was 1.2 ± 0.6 days. Mean duration of follow-up was 14 ± 6 months. Patients with unilateral undescended testes; 2 had orcheidopexy, one had first stage Fawler-Stephens, and one had orcheidectomy. Patients with bilateral undescended testicles; one had orcheidopexy, one had right orcheidopexy and left first stage Fawler-Stephens and third had bilateral first stage Fawler-Stephens. All patients who had first stage Fawler-Stephens orcheidopexy subsequently had LESS second stage orcheidopexy after 6 months. Follow-up of patient with left UPJO showed complete clinical cure and patent ureteropelvic junction and marked decrease of left hydronephrosis. In all patients umbilical scar was invisible and patients had high wound satisfaction. CONCLUSIONS: LESS is a feasible, effective and safe option for treatment of many urologic pathologies in pediatrics. However, more patients and indications are need for further evaluation of role of LESS in pediatric urology.
Laparoendoscopic single-site surgery (LESS) for treatment of different urologic pathologies in pediatrics: Initial experience Eur Urol Suppl 2013;12;e537
Abdel-Karim A., Moussa A., Elmissery M., Abolfotoh A., Mahfouz W., Elsalmy S. Alexandria University, Dept. of Urology, Alexandria, Egypt INTRODUCTION & OBJECTIVES: Laparoendoscopic single-site surgery (LESS) has been increasingly reported as a new less invasive approach for treatment of various urologic pathologies in adults. However, the applications of LESS in the field of pediatric urology are still limited. In this study we present our initial experience with LESS as an option for treatment of some pediatric urologic pathologies. MATERIAL & METHODS: This is a retrospective study that included 12 pediatric patients with a mean age 5.2 ± 2.7 years. Four patients had unilateral undescended testes, 3 with bilateral undecended testes, 2 with left and one with bilateral varicocele, one with right multicystic dysplastic kidney and one with left ureteropelvic junction obstruction (UPJO). Ports used were R-port (10 patients) and Covieden port (2 patients) and the ports were inserted through the umbilicus. We used pre-bent (with R-port), articulating (with Covieden port) as well as straight instruments. In patient with left UPJO, LESS dismembered pyeloplasty was done through hand free suturing technique using 4/0 vicryl sutures. RESULTS: In all patients there was no conversion to conventional laparoscopy or open surgery. We did not add any extraport in any of the patients. Mean operative time 110 ± 45 minutes. Mean blood loss was 40 ±30 c.c. No intraoperative or postoperative complications were reported. Mean hospital stay was 1.2 ± 0.6 days. Mean duration of follow-up was 14 ± 6 months. Patients with unilateral undescended testes; 2 had orcheidopexy, one had first stage Fawler-Stephens, and one had orcheidectomy. Patients with bilateral undescended testicles; one had orcheidopexy, one had right orcheidopexy and left first stage Fawler-Stephens and third had bilateral first stage Fawler-Stephens. All patients who had first stage Fawler-Stephens orcheidopexy subsequently had LESS second stage orcheidopexy after 6 months. Follow-up of patient with left UPJO showed complete clinical cure and patent ureteropelvic junction and marked decrease of left hydronephrosis. In all patients umbilical scar was invisible and patients had high wound satisfaction. CONCLUSIONS: LESS is a feasible, effective and safe option for treatment of many urologic pathologies in pediatrics. However, more patients and indications are need for further evaluation of role of LESS in pediatric urology.