Steyaert H, Valla J S
Department of Paediatric Surgery, Fondation Lenval, 57 Avenue de la Californie, 06200 Nice, France.
Eur J Pediatr Surg. 2005 Oct;15(5):307-13. doi: 10.1055/s-2005-865805.
Laparoscopy has emerged as a feasible and effective alternative for abdominal pathologies in children. Urological minimally invasive surgery is now commonly used for basic operations in most centres and is just beginning to expand its use in more complex operations in several selected centres around the world. We present the current state of the art of minimally invasive surgery in children.
We first reviewed all the urological pathologies treated with minimally invasive surgery in our institution. Secondly we reviewed the literature in order to highlight and discuss certain relevant articles and compare them with our own experience.
Since beginning to use minimally invasive surgery at our institution we have operated more than 550 cases with urological pathologies. We used three approaches: the transperitoneal, the retroperitoneal and the transvesical approach. Our preferred indications for each approach are discussed.
Non palpable testis, varicocele surgery, nephrectomy and adrenalectomy are, in our opinion, established minimally invasive procedures. Hemi-nephrectomy, pyeloplasty and Cohen antireflux surgery are probably excellent indications when minimally invasive surgery is carried out by expert hands. Stone management should not be forgotten in cases of contraindication or failure of ESWL. Even the most complex urological operations may be safely carried out using a minimally invasive approach, although most of the cases described are case reports.
More papers are published on ablative or reconstructive urological minimally invasive surgery. Transperitoneal and retroperitoneal approaches are used with the same results. Transvesicoscopic surgery should rapidly grow to become a standard approach for Cohen reimplantation. It is anticipated that technical progress will provide the opportunity for more paediatric urologists to develop a minimally invasive approach.
腹腔镜检查已成为治疗儿童腹部疾病的一种可行且有效的替代方法。泌尿外科微创手术目前在大多数中心已普遍用于基本手术，并且在世界上几个选定的中心刚刚开始在更复杂的手术中扩大其应用。我们介绍了儿童微创手术的当前技术水平。
我们首先回顾了在本机构接受微创手术治疗的所有泌尿外科疾病。其次，我们查阅了文献，以突出和讨论某些相关文章，并将它们与我们自己的经验进行比较。
自本机构开始使用微创手术以来，我们已对550多例泌尿外科疾病患者进行了手术。我们采用了三种方法：经腹、腹膜后和经膀胱途径。我们讨论了每种方法的首选适应症。
在我们看来，不可触及睾丸、精索静脉曲张手术、肾切除术和肾上腺切除术是已确立的微创手术。当由专家进行微创手术时，半肾切除术、肾盂成形术和科恩抗反流手术可能是极好的适应症。在体外冲击波碎石术（ESWL）禁忌或失败的情况下，结石处理不应被忽视。即使是最复杂的泌尿外科手术，也可以使用微创方法安全地进行，尽管所描述的大多数病例都是病例报告。
关于泌尿外科微创消融或重建手术的论文发表得越来越多。经腹和腹膜后途径的使用效果相同。经膀胱镜手术应迅速发展成为科恩再植术的标准方法。预计技术进步将为更多儿科泌尿外科医生提供发展微创方法的机会。
