Laparoscopic Reconstructive Surgery in Pediatric Urology: An Overview of Current Options

Yoshiyuki      Kojima; Keiichi      Tozawa; Kenjiro      Kohri; Yutaro      Hayashi

Abstract

Open surgery remains the standard surgical repair for urological anomalies in the pediatric population; however, with the development of instruments and the innovation of pediatric urologists, laparoscopic reconstructive surgery has gained acceptance as a feasible and reliable treatment associated with minimal morbidity, because it has several advantages over standard open reconstructive surgery. The main advantages of laparoscopic reconstructive surgery include improved cosmetic outcome, more rapid recovery, less postoperative pain, and consequently, lower analgesic requirements and shorter hospital stays. In addition, these surgeries enable increased magnification and improve visualization. On the other hand, the limitations and difficulty of laparoscopic suturing may be one of the major disadvantages to the widespread application of laparoscopic reconstructive surgery, because laparoscopic suturing in children is challenging and time-consuming and requires a learning curve. Robotic-assisted laparoscopic surgery has several advantages over conventional laparoscopic surgery, with the main advantage being the simplification and precision of exposure and suturing because of an increased degree of freedom and a magnified 3-dimensional view. These features make robotic-assisted laparoscopic surgery ideal for complex reconstructive surgery, and the number of robotic systems has increased in recent years. In this review, we discuss the recent advances in laparoscopic reconstructive surgery for urological anomalies in the pediatric population, and provide a critical summary of current knowledge on its indications, procedures and outcome. In conclusion, almost all operations that are classically performed as open reconstructive surgery for children with urological anomalies could be replaced with laparoscopic surgery and established as minimally invasive surgery in the future.

Keywords: Laparoscopy, minimally invasive surgery, robotics, pediatrics, urology, urinary tract reconstruction, Laparoscopic Reconstructive Surgery, LAPAROSCOPIC NEPHRECTOMY, transperitoneal, retroperitoneal, LAPAROSCOPIC HEMINEPHROURETERECTOMY, LAPAROSCOPIC PYELOPLASTY, URETEROPELVIC JUNCTION OBSTRUCTION (UPJO), hydronephrosis, LAPAROSCOPIC URETERAL REIMPLANTATION, VESICOURETERAL REFLUX (VUR), Cohen procedure, Lich-Gregoir procedure, Vesicoscopic Approach, LAPAROSCOPIC APPEDICOVESICOSTOMY, LAPAROSCOPIC ORCHIOPEXY, LAPAROSCOPIC GONADECTOMY, pyelolithotom, retrocaval ureter, adrenalectomy, bladder neck sling, Mullerian duct remnants, urachal remnant