Laparoendoscopic single-site surgery (LESS) for the treatment of different urologic pathologies in pediatrics: Single-center single-surgeon experience.

Journal of pediatric urology

PubMedID: 25459388

Abdel-Karim AM, Elmissery M, Elsalmy S. Laparoendoscopic single-site surgery (LESS) for the treatment of different urologic pathologies in pediatrics: Single-center single-surgeon experience. J Pediatr Urol. 2014;.
OBJECTIVE
Although there are increasing reports in the literature about laparoendoscopic single-site surgery (LESS) as a tool for treatment of different pathologies in adults, the applications of LESS in pediatric urology are still limited. In this report we present the largest case series of LESS as an option for treatment of different urologic pathologies in pediatrics.

MATERIALS AND METHODS
From January 2011 to June 2013, LESS was done for variable urologic pathologies in pediatrics. Indications of LESS included undescended testes, varicocele, nehrectomy for both non-functioning and multicystic dysplastic kidneys as well as pyeloplasty. Both R-port and Covedien port were used, and were inserted through a periumbilical skin incision. Whenever R-port was used, we used both pre-bent and straight instruments, whereas with Covedien port both articulating and straight instruments were used. Pyeloplasty was done through hands-free intracorporeal suturing using 4/0 vicryl. All procedures were done by a single experienced laparoscopist. Data were collected during and after surgery then analyzed retrospectively.

RESULTS
Twenty-two children with mean age of 6.3 ± 4.2 years had 39 LESS procedures. Thirteen patients had undescended testes (bilateral = 7, unilateral = 6, total = 20 undescended testes); 10 of them had primary orchiopexy, while nine had first stage Fowler-Stephens orchiopexy and these children subsequently had second stage Fowler-Stephens orchiopexy after 6 months and one child had orchiectomy. Four patients with varicocele (left = 3, bilateral = 1) had varicocelectomy. Two children had nephrectomy for both non-functioning hydronephrotic as well as multicystic dysplastic kidneys. Three children with ureteropelvic junction obstruction had LESS pyeloplasty, of whom two had dismembered pyeloplasty and one had non-dismembered Y-V plasty. There was no conversion to conventional laparoscopy, open surgery or adding an extra-port in any patient. Mean operative time was 89.6 ± 22.8 min. Mean blood loss was 32.2 ± 22.1 cc. No intraoperative or postoperative complications were reported. Mean hospital stay was 0.5 ± 0.6 days. Mean visual analog pain scale at discharge was 0.5 ± 0.3. Mean follow-up was 18.6 ± 6.4 months.

CONCLUSION
LESS is a feasible and safe option for treatment of different urologic pathologies in pediatrics. However, more patients, indications and prospective comparative studies are needed for further evaluation of the role of LESS in pediatric urology.