Bilateral Laparoscopic Heminephrectomy in a Child with Bilateral Ectopic Ureter: The Case for Minimal Invasive Surgery
Abstract Purpose The laparoscopic approach is regarded today as an excellent option for renal ablative and reconstructive surgery in adults and older children. In case of bilateral renal surgery it has potential advantages over open surgery in terms of morbidity, use of analgesics and recovery. We present a video of a child with bilateral ectopic ureter treated by simultaneous bilateral laparoscopic heminephrectomy. Material and Methods We present a case of a 6 year old female patient with bilateral complete renal duplicity and upper pole hydronephrosis, presenting with insensitive urinary loss with preserved micturitions and breakthrough UTI. The patient was positioned in oblique dorsal 45 degrees decubitus and a transperitoneal approach with 4 ports was made (2 of 12mm and 2 of 5mm). The dilated ureter was identified at the distal third and cranially dissected up to the upper renal pole and ressected with selective clamping of arterial branch. After decubitus change the same procedure was performed for the other side. The distal ureter stumpf was left open after urin aspiration. Results The surgery took 480 minutes, with approximately 220 minutes for each side and 40 minutes for repositioning the patient. The clinical evolution was uneventful, the patient was dismissed on the 4th postoperative day totally dry. Conclusions We believe that transperitoneal laparoscopic approach is the option of choice for bilateral heminephrectomy also in children.