What to anticipate with experience in pediatric laparoscopic ablative renal surgery

Purpose: Laparoscopic renal surgery in pediatric urology is moving forward at a slower pace than desired. To guide beginning surgeons in what to expect in their first years of surgical experience, we present our first 6 years of pediatric laparoscopic ablative renal surgery experience to highlight the changing laparoscopic surgical parameters during this interval. Materials and Methods: We retrospectively analyzed all children who underwent laparoscopic ablative renal surgery (nephrectomy and heminephroureterectomy) performed by 1 surgeon between January 2000 and December 2005. After searching the medical, operative and anesthesia records we compared patient characteristics and operative parameters such as blood loss and operative time through the years. Results: A total of 39 children (25 girls, 14 boys) with a mean age of 6.9 years underwent laparoscopic renal surgery. Mean operative time was 204 minutes for nephrectomy (26 cases) and 291 minutes for heminephroureterectomy (14). A statistically significant decrease in operative time was noted in the fourth year for nephrectomy cases (20 cases, p = 0.003). Blood loss decrease was significant at the fourth year after 10 cases of heminephroureterectomy (p = 0.036). Thus, operative time was the only changing parameter with experience in nephrectomy, while blood loss changed in heminephroureterectomy. Conclusions: This report details the operative parameters changing during the first 6 years as our experience increased in an academic setting. This outcome serves as a realistic guide regarding expectations for beginning laparoscopists, and should encourage the continuation of pediatric laparoscopic renal surgery.