Pediatric nephrectomy is the procedure involving the removal of the kidney in children. Nephrectomy is often needed for large, painful, and abnormal kidneys with high blood pressure that cannot be controlled or non-working kidneys that are due to severe urine backflow. Some children also need this procedure because of urinary tract infections caused by non-working kidneys from blockage in the kidney's renal pelvis.
Laparoscopy, a minimally invasive procedure, had initially limited diagnostic and therapeutic uses. With new tools like automatic clip appliers, staplers, organ removal bags and morcellators, many more procedures can now be done using laparoscopy. These advances have made it possible to perform laparoscopic varicocelectomies, bladder enlargements, urinary diversions, ureterolysis, adrenal gland removals, kidney removals and kidney-ureter removals. Such advances have allowed for decreased post-operative discomfort and healing time as well as improved cosmetic results.
The team at WCM has perform over 50 pediatric laparoscopic nephrectomies, as well as both laparoscopic nephroureterectomies and partial nephrectomies with urethrectomy.
Laparoscopic Nephroureterectomies:
- The removal of kidney and entire ureter (the tube that drains urine from kidney to bladder)
- Many children who undergo this procedure have non-functioning kidneys due to severe vesicoureteral reflux, when the infected urine flows back into the kidney, causing chronic infection and scarring
- Scarred kidneys with ongoing infections need to be removed
Partial Nephrectomies with Urethrectomy:
- Performed on children with urinary tract infections and duplicated collecting systems
- With this procedure, the non-functioning part of the duplicated kidney is separated from the functioning part to preserve kidney function
How We Perform Pediatric Laparoscopy Nephrectomy
Patients undergoing pediatric laparoscopy nephrectomy are administered general endotracheal anesthesia, meaning the child is completely asleep with anesthesia. At a high-level, these steps include:
- Use of an “endotracheal tube” to protect the airway
- Perform a formal cystoscopy using a camera to look inside the bladder and pass a stent with an infrared laser fiber for identifying and dissecting the ureter, as needed.
- Three small skin incisions, each about 1.5 cm, are made for the laparoscopic camera and surgical instruments. These incisions are small enough to protected with a Band-Aid at the end of the procedure.
- The first incision is made in the upper part of the belly button. Carbon dioxide gas is then used to inflate the belly, giving room to see and perform the procedure.
- The other two incisions are made just below the rib over the affected kidney and near the hipbone.
4. With all the instruments in place, the kidney and ureter are separated from surrounding tissues and removed laparoscopically.
5. At the end of the procedure, the abdominal cavity is inspected for any bleeding. Once all bleeding is stopped, the skin incisions are covered with Band-Aids or sterile dressings.
After the patient wakes up in the operating room, they are taken to the recovery room. Most children can eat a regular meal and go home the same day, while some may need to stay an extra day until they can tolerate a regular meal.
Advantages of Pediatric Laparoscopy Nephrectomy
Laparoscopy and minimally invasive surgery are becoming more common and a standard treatment approach for a number of conditions in pediatric urology. The primary advantages include:
- Decreased post-operative pain
- Short hospital stays, with the possibility of performing such procedures on an outpatient basis in select patients
- Improved cosmetic results
Potential Complications for Pediatric Laparoscopy Nephrectomy
Potential complications from pediatric laparoscopy nephrectomy include infection, bleeding, and anesthesia related complications.
With that said, at Weill Cornell Medicine Department of Urology, no case has ever been converted to an open procedure, meaning we are able to perform all cases laparoscopically, as intended. Additionally, not a single child has been transfused and our blood loss averages less than 5 cc (a tablespoon). The team at WCM is comprised of a talented staff of pediatric anesthesiologists who only administer anesthesia to children and are specialty trained in pediatric anesthesia. With their help, we have a 0% rate of anesthesia related complications during our laparoscopic cases.
Would you like an appointment?
To request an appointment or learn more about our program, please call our office at (212) 746-5337. Our phone staff is available Monday through Friday, 9 AM to 5PM (EST).
Meet our expert providers who specialize in Pediatric Laparoscopy Nephrectomy:
