Division of Pediatric Surgery and Pediatric Urology, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China.
Urology. 2013 Aug;82(2):430-5. doi: 10.1016/j.urology.2013.02.057. Epub 2013 May 2.
To investigate the safety and effectiveness of laparoendoscopic single-site surgery (LESS) using standard laparoscopic setup in pediatric nephrectomy/heminephroureterectomy (HN) by comparing with conventional laparoscopy (CL).
Twelve consecutive children who underwent LESS (nephrectomy = 8, HN = 4) from 2009 to 2012 were compared with a matched cohort of 18 children who underwent CL (nephrectomy = 12, HN = 6) at the same institution. Data were reviewed retrospectively.
There was no difference between the 2 groups in the age of patients, body weight, gender distribution, laterality of pathology, postoperative analgesic requirement, and hospital stay. Eleven of the 12 children in the LESS group underwent the procedure successfully without additional trocar placement. The only open conversion happened in the case of LESS of the lower moiety HN. LESS nephrectomy took longer operative time than CL (mean 156 +/- 45 vs 99 +/- 35 minutes, median 155 vs 90 minutes, P <.01). Wound infection occurred in 1 patient after CL nephrectomy. No postoperative complication or access site hernia was noted in the children in the LESS group at follow-up.
LESS nephrectomy and HN in the pediatric population is safe and effective with a minimally invasive nature comparable to CL. Learning curve factors may contribute to the reported longer operative time in LESS. Further studies are required to investigate the implication of patient selection and the cosmetic benefits of LESS, which may potentially require longer operative time.
通过与传统腹腔镜手术（CL）比较，研究使用标准腹腔镜设备进行小儿肾切除术/半肾输尿管切除术（HN）的腹腔镜单部位手术（LESS）的安全性和有效性。
2009 年至 2012 年间，我们对 12 例连续接受 LESS（肾切除术=8 例，HN=4 例）的儿童与同一机构的 18 例接受 CL（肾切除术=12 例，HN=6 例）的匹配队列进行了比较。数据进行回顾性分析。
两组患者的年龄、体重、性别分布、病变侧、术后镇痛需求和住院时间均无差异。12 例 LESS 组中有 11 例成功完成手术，无需额外放置套管针。唯一的中转开腹手术发生在 LESS 下 HN 下段切除术。LESS 肾切除术的手术时间长于 CL（平均 156±45 比 99±35 分钟，中位数 155 比 90 分钟，P<.01）。CL 肾切除术后 1 例发生伤口感染。在 LESS 组的患儿随访中，无术后并发症或切口疝。
LESS 肾切除术和小儿 HN 具有微创性，与 CL 一样安全有效。学习曲线因素可能导致 LESS 报告的手术时间较长。需要进一步研究以探讨患者选择和 LESS 的美容益处的影响，这可能需要更长的手术时间。
