Department of Pediatric Surgery and Pediatric Urology, University Children's Hospital, Hoppe-Seyler-Strasse 3, 72076, Tuebingen, Germany.
J Pediatr Surg. 2013 May;48(5):1142-6. doi: 10.1016/j.jpedsurg.2013.01.040.
BACKGROUND/PURPOSE: The purpose of this study was to assess different surgical approaches for laparoendoscopic single-site nephroureterectomy according to weight groups.
LESS nephroureterectomy was performed in 11 children. Indication for nephrectomy was a non-functioning kidney owing to vesicoureteral reflux or giant cystic dysplasia. Children below 10 kg body weight underwent LESS nephroureterectomy through an umbilical incision using one 5mm and two 3mm trocars (Manhattan technique). Patients above 10 kg were operated on using a metal multi-use single-site single port (X-Cone).
Median age at operation was 12 months (0.75-128), and median weight was 8.5 kg (3.1-67). Median operating time was 110 minutes (50-260). Eight children underwent LESS nephroureterectomy using the Manhattan-technique, and three patients were operated on with the X-Cone. All operations were carried out in a transperitoneal technique without using additional trocars. There were no complications. Recovery was uneventful in all children.
LESS nephroureterectomy for pediatric patients can be done safely and efficiently, irrespective of age and weight. However, different surgical approaches have to be considered owing to the fact that single-site ports are not available for small children and infants. Both techniques will benefit from future development of instruments and trocars more suitable for small children. The question whether LESS provides even less trauma than in conventional laparoscopy remains doubtful.
背景/目的：本研究旨在根据体重组评估腹腔镜单部位肾输尿管切除术的不同手术入路。
对 11 名儿童进行了LESS 肾输尿管切除术。因膀胱输尿管反流或巨大囊性发育不良而导致肾功能丧失的情况下需要进行肾切除术。体重低于 10kg 的儿童通过脐部切口使用一个 5mm 和两个 3mm 的trocar（曼哈顿技术）进行 LESS 肾输尿管切除术。体重超过 10kg 的患者使用金属多用单部位单端口（X-Cone）进行手术。
手术时的中位年龄为 12 个月（0.75-128），中位体重为 8.5kg（3.1-67）。中位手术时间为 110 分钟（50-260）。8 名儿童采用曼哈顿技术进行 LESS 肾输尿管切除术，3 名患者采用 X-Cone 进行手术。所有手术均采用经腹腔技术进行，无需额外的trocar。没有发生并发症。所有儿童的恢复均顺利。
无论年龄和体重如何，小儿患者的LESS 肾输尿管切除术都可以安全有效地进行。然而，由于单部位端口不适用于小儿童和婴儿，因此必须考虑不同的手术入路。随着更适合小儿童的器械和trocar的未来发展，这两种技术都将受益。LESS 是否比传统腹腔镜提供更少的创伤仍值得怀疑。
