New Laparoscopic Technique Permits Shorter Hospital Stays With Less Pain and Scarring
Mar 8, 2000
Pediatric urologists at Weill Cornell Medical Center of New York-Presbyterian Hospital have performed among the first minimally invasive kidney removals in children and infants in the metropolitan area. Such laparoscopic nephrectomies, as they are known, result in shorter hospital stays, less post-operative pain, and less scarring. The team of pediatric urologists, led by Dr. Dix Poppas, recently completed and evaluated a large series of such procedures in order to establish their safety and efficacy for benign kidney disease.
Background and Major Points
- Dix P. Poppas, MD—the Richard Rodgers Family Assistant Professor, Director of Pediatric Urology, and Director of the Laboratory of Alternative Tissue Repair and Minimally Invasive Surgery at New York Weill Cornell—has championed the development and use of laparoscopic and minimally invasive surgical techniques in the field of pediatric urology. He has also contributed to major advances in the areas of wound healing and laser tissue welding.
- Laparoscopic nephrectomy (kidney removal)—and the related procedures of laparoscopic nephroureterectomy (removal of kidney and part or all of ureter) and laparoscopic heminephroureterectomy (removal of half of kidney)—can now be performed successfully in children with benign kidney disease with minimal morbidity, minimal post-operative discomfort, short hospital stays (even same-day surgery), and excellent cosmetic results.
- The laparoscopic technique is a less invasive surgical procedure employing a long, slender optical instrument inserted through a small incision in the abdominal wall to allow visualization on a television monitor and to guide the entire surgical procedure.
- The recent series of operations that were evaluated included 26 children, 15 girls and 11 boys, age 4 months to 11 years. This population underwent laparoscopic renal procedures (of the three varieties mentioned in #1 above) over a period of two years.
- The average operative time for all procedures was under three hours, but the procedures are currently being completed in less than 90 minutes. Blood loss was minimal in all cases, and there were no intra-operative complications. Use of post-operative pain medication was quite minimal overall. Twenty of the 26 patients were discharged home the same day as surgery or the next day. Cosmetic results were excellent without exception.
- With the advent of new instruments, such as automatic clip appliers, impermeable organ isolation and removal bags, and morcellating devices (which divide solid tissue into pieces in order to remove them piecemeal), the range of procedures that can be performed using a laparoscope has been broadened substantially. In urology, additional laparoscopic procedures include laparoscopic orchidopexy (for undescended testes), urinary diversions, bladder augmentations, ureteral reconstruction, and adrenalectomy (removal of the adrenal gland).