Experience With Laparoscopic Radical Nephrectomy In Wilms’ Tumor
PURPOSE To present our experience with laparoscopic radical nephrectomy in children with Wilms’ tumor. MATERIAL AND METHODS Fifteen selected children with non-metastatic unilateral Wilms’ tumor, with preoperative chemotherapy and significant reduction in the tumoral size, were submitted to laparoscopic radical nephrectomy. After colonic and hepatic (or splenic) mobilization, the kidney is exposed and the renal vessels dissected and sectioned. After ureteral section, the kidney is dissected with its perirenal fat, and the adherences to the neighboring structures are sectioned. A lymphatic sample is obtained from the peri-hilar region. The tumoral kidney is removed through a Pfannenstiehl incision. The incision and accesses are closed without drainage. RESULTS The patients aged 10-108 months (∼47.2) and weighed 8-27 kg (∼18.2). Removal of the tumoral kidney and lymphatic samples was possible in all cases. The formation of a tumoral capsule, due to preoperative chemotherapy, allowed the safe mobilization of the kidney, preventing rupture. There was no bleeding nor injury to the neighboring structures. Mean operative time was 149.6 min. (120-180). The weight of the specimen was ∼124.7g (55-234). Post-operative course was uneventful and discharge varied from 2-3 days. Adjuvant chemotherapy was made in all patients, and there were no recurrences. All resected kidneys had a pre-operative tumoral diameter on CT less than 10% of the children's height. CONCLUSIONS Laparoscopic radical nephrectomy is a feasible and safe alternative in the treatment of non-metastatic unilateral Wilms’ tumor after chemotherapy, with significant advantages over open surgery, considering the post-operative course and cosmesis.