laparoscopy-in-children

laparoscopy-in-children - LAPAROSCOPY IN CHILDREN –...

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Unformatted text preview: LAPAROSCOPY IN CHILDREN – REVIEW OF OUR EXPERIENCE Hemraj, RAMESH BABU S Pediatric urology unit SRI RAMACHANDRA MEDICAL COLLEGE AND RESEARCH INSTITUTE CHENNAI INTRODUCTION INTRODUCTION Laparoscopy has become the mainstay of treatment for many conditions in adult urology. Diagnostic laparoscopy was done 30 years ago in pediatric urology for diagnosing non palpable testes1. Era of therapeutic laparoscopy began with introduction of clipping for 1st stage Fowler­Stephens operation in 19912 and laparoscopic orchidopexy was performed in 19943. 1. Cortesi N, Ferrari P, Zambarda E, et al: Diagnosis of bilateral abdominal cryptorchidism by laparoscopy. Endoscopy 1976;8:33. 2. Bloom DA: Two­step orchiopexy with pelviscopic clip ligation of the spermatic vessels. J Urol 1991;145:1030–1033. 3. Jordan GH: Will laparoscopic orchiopexy replace open surgery for the nonpalpable undescended testis? [editorial; comment]. J Urol 1997;158:1956. Introduction Introduction Development of laparoscopy in pediatric urology was slower when compared to adults. With availability of expertise and equipments, more centers have started using laparoscopic approach for management of pediatric urological problems. MATERIALS AND METHODS MATERIALS AND METHODS All the children who underwent laparoscopy for various paediatric urological problems from July 2006 to June 2008 were included in the study. General principles General principles Open Hassan’s technique was used for umbilical port in all the cases Transperitoneal approach was adapted in all the cases Ports – – – 10 mm and 5 mm ports were used Two lateral ports and one umbilical port were used Whenever indicated a fourth port was used Intra abdominal pressure – Was always kept low at about 8 – 10 mmHg Port placement Port placement 0 10mm 05mm 010mm 05mm Right nephrectomy 05mm 010mm 05mm 010mm Left nephrectomy Procedures Procedures Lap orchidopexy Lap Ureterolysis Lap assisted nephrectomy Lap nephrectomy Lap assisted pyeloplasty 3 Lap pyeloplasty Total 6 1 3 7 1 21 RESULTS RESULTS The mean operating time was 3 hours ( 2 – 3.5 hours ) The operating time was higher in the initial cases (3.5 hours) With the learning curve, the current operating time has come down further Results Results Conversion rate – 3/21 procedures (14%) – 1 nephrectomy; 2 pyeloplasty Intra operative problems (during early stages) – Bowel distension (avoid nitrous oxide, Pre op enema) – Hyper carbia (using low pressures, intermittent deflation) Duration of hospital stay – Mean duration 4.5 days (3­8 days) – Main reason to stay was to establish feeds, IV antibiotics etc Paediatric Laparoscopy Vs Adult Paediatric Laparoscopy Vs Adult Advantages – Well defined tissue planes – Thin abdominal wall – Smaller vessels, amenable to clips / diathermy Limitations – Limited space, Ports clash – Size of the instruments – Complications such as bowel injury DISCUSSION DISCUSSION Laparoscopy offers reduced hospital stay, reduced complications and superior cosmetic results in children More complex procedures can be performed with ease Multiple problems can be tackled with planning ports With experience, the operating time is significantly reduced nearing to that of a open procedure. THANK YOU ...
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This note was uploaded on 01/16/2012 for the course BI 200 taught by Professor Potter during the Fall '11 term at Montgomery College.

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