Division of Pediatric Surgery, Federico II University of Naples, Via Pansini 5, 80131, Naples, Italy.
Division of Pediatric Surgery, Buzzi Children Hospital, Milan, Italy.
Surg Endosc. 2019 Mar;33(3):832-839. doi: 10.1007/s00464-018-6349-z. Epub 2018 Jul 13.
Very limited informations are currently available about the best approach to perform retroperitoneoscopic surgery. This multicentric international study aimed to compare the outcome of lateral versus prone approach for retroperitoneoscopic partial nephrectomy (RPN) in children.
The records of 164 patients underwent RPN in 7 international centers of pediatric surgery over the last 5 years were retrospectively reviewed. Sixty-one patients (42 girls and 19 boys, average age 3.8 years) were operated using lateral approach (G1), whereas 103 patients (66 girls and 37 boys, average age 3.0 years) underwent prone RPN (G2). The two groups were compared in regard to operative time, postoperative outcome, postoperative complications, and re-operations.
The average operative time was significantly shorter in G2 (99 min) compared to G1 (160 min) (p = 0.001). Only 2 lateral RPN required conversion to open surgery. There was no significant difference between the two groups as for intraoperative complications (G1:2/61, 3.3%; G2:6/103, 5.8%; p = 0.48), postoperative complications (G1:9/61, 14.7%; G2:17/103, 16.5%; p = 0.80), and re-operations (G1:2/61, 3.3%; G2:4/103, 3.8%; p = 0.85). Regarding postoperative complications, the incidence of symptomatic residual distal ureteric stumps (RDUS) was significantly higher in G2 (7/103, 6.8%) compared to G1 (1/61, 1.6%) (p = 0.001). Most re-operations (4/6, 66.6%) were performed to remove a RDUS .
Both lateral and prone approach are feasible and reasonably safe to perform RPN in children but the superiority of one approach over another is not still confirmed. Although prone technique resulted faster compared to lateral approach, the choice of the technique remains dependent on the surgeon's personal preference and experience. Our results would suggest that the lateral approach should be preferred to the prone technique when a longer ureterectomy is required, for example in cases of vesico-ureteral reflux into the affected kidney moiety, in order to avoid to leave a long ureteric stump that could become symptomatic and require a re-intervention.
目前关于后腹腔镜手术的最佳方法，仅有非常有限的信息。这项多中心国际研究旨在比较儿童后腹腔镜部分肾切除术（RPN）中侧卧位与俯卧位的结果。
回顾性分析过去 5 年 7 家国际小儿外科中心的 164 例接受 RPN 的患者的记录。61 例患者（42 名女性和 19 名男性，平均年龄 3.8 岁）采用侧卧位（G1）进行手术，而 103 例患者（66 名女性和 37 名男性，平均年龄 3.0 岁）采用俯卧位 RPN（G2）。比较两组患者的手术时间、术后结果、术后并发症和再次手术情况。
G2 的平均手术时间明显短于 G1（99 分钟比 160 分钟）（p=0.001）。仅 2 例侧卧位 RPN 需要转为开放手术。两组患者术中并发症（G1：2/61，3.3%；G2：6/103，5.8%；p=0.48）、术后并发症（G1：9/61，14.7%；G2：17/103，16.5%；p=0.80）和再次手术（G1：2/61，3.3%；G2：4/103，3.8%；p=0.85）无显著差异。在术后并发症方面，G2 中症状性残留远端输尿管残端（RDUS）的发生率明显高于 G1（G2：7/103，6.8%；G1：1/61，1.6%）（p=0.001）。大多数再次手术（4/6，66.6%）是为了切除 RDUS。
儿童后腹腔镜 RPN 中，侧卧位和俯卧位均可行且相对安全，但一种方法优于另一种方法的优势尚未得到证实。尽管俯卧位技术比侧卧位技术更快，但技术的选择仍然取决于外科医生的个人偏好和经验。我们的结果表明，当需要进行较长的输尿管切除术时，例如在膀胱输尿管反流进入受影响的肾部分时，应优先选择侧卧位技术，以避免留下可能出现症状并需要再次干预的长输尿管残端。
