Retroperitoneoscopic varicocelectomy in children and adolescents

Abstract BACKGROUND/PURPOSE: In the pediatric population the failure rate of sclerotherapy for the treatment of varicocele has been reported to be up to 35%. Therefore, the aim of our study was to evaluate the efficacy of retroperitoneoscopic varicocelectomy (RV) in children and adolescents. METHODS: A total of 97 patients were operated on for left-sided varicocele using the retroperitoneoscopic approach between January 1999 and July 2003. Median age was 12.3 years (range, 6-16 years). A 10-mm subcostal retroperitoneoscopic port was used. The operation was performed through an operative laparoscope according to Palomo's technique, with the mass division of spermatic vessels after bipolar coagulation below the renal vein. Elective conversion to laparoscopic transperitoneal varicocelectomy was performed in cases of difficulties in identifying the vessels. The postoperative follow-up included clinical and ultrasound assessment (range, 6-48 months). RESULTS: A total of 17 (17.6%) patients needed elective conversion to laparoscopic transperitoneal varicocelectomy. In RV, the mean operative time was 28 minutes (range, 15-55 minutes), the mean hospital stay was 2 days, persistence rate was 11.2%, and hydrocele occurrence was 6.2%. CONCLUSIONS: Our results indicate that the RV is an acceptable technique to achieve the high division of the spermatic vessels. The advantage of this anatomic approach is its very low invasiveness

One-trocar transumbilical laparoscopic-assisted management of Meckel's diverticulum in children

Abstract PURPOSE: Transumbilical laparoscopic-assisted intestinal surgery using only "one trocar" is a very minimal invasive procedure. The authors present their experience for the management of Meckel's diverticulum. MATERIALS AND METHODS: Between January 2001 and December 2004, 9 transumbilical laparoscopic-assisted procedures were performed for Meckel's diverticulum. The median age of the patients was 6.1 years (range, 6 months-13.6 years). Six patients were admitted for intestinal bleeding and technetium-99m pertechnetate scan was positive in 3. Three patients had recurrent abdominal pain and abdominal ultrasound scan showed a cystlike structure. An intraumbilical Hasson 10-mm trocar was inserted in an open fashion. Using a 10-mm operative laparoscope, the terminal ileum was grasped with an atraumatic instrument and exteriorized through the umbilicus. Ileal exploration and treatment were performed extracorporeally. RESULTS: Meckel's diverticulum was identified in 8 patients and ileal duplication in 1 patient: intestinal resection/anastomosis (n = 7) or excision of diverticulum (n = 2) was performed. There were no operative complications. Median hospital stay was 4 days (range, 3-7 days). At a median followup of 24 months (range, 3-51 months), all patients are asymptomatic. CONCLUSION: Our results indicate that the one trocar transumbilical laparoscopic-assisted procedure is safe and effective for the diagnosis and treatment of Meckel's diverticulum, with excellent cosmetic results

Robotic-assisted excision of a giant ureteral stump in a child: Case report and Non-systematic review of the Literature

Background: Radical removal of the ureter is not routinary performed during nephrectomy/hemineprectomy, distal ureteral stump syndrome may follow. Case summary: A 17-year-old male with urinary malformation history came to the emergency department for abdominal pain and tenesmus. Imaging revealed a huge abdominal mass, compatible with a massively dilated residual ureteral stump resulting from heminephrectomy operation performed 7 years before for a complete right duplex system with hypoplasia of the upper right system. A robotic procedure was planned and the stump, which was ectopic and drained into the seminal vesicles, was successfully removed. The patient was discharged after recovery; he was followed up for one year after surgery without any complications. Conclusion: Ureteral stumps rarely require reoperation, but our case suggests a need for long-term follow-up. Robotic-assisted excision showed to be a safe and effective technique for surgical management of a massively dilated ectopic stump in the pediatric population