Heminephrectomy in the pediatric population – single-center comparison of the open versus transperitoneal laparoscopic approach
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Pediatric Surgery Students’ Association, School of Medicine, Collegium Medicum, University of Warmia and Mazury in Olsztyn, Poland
Department of Surgery, School of Public Health, Collegium Medicum, University of Warmia and Mazury in Olsztyn, Poland
Clinical Ward of Paediatric Surgery and Urology, Regional Specialised Children’s Hospital in Olsztyn, Poland
Submission date: 2022-04-20
Final revision date: 2022-12-15
Acceptance date: 2022-12-15
Online publication date: 2023-10-15
Corresponding author
Michał Starczewski   

Pediatric Surgery Students' Association, School of Medicinie, Collegium Medicum, University of Warmia and Mazury in Olsztyn, Warszawska 30, 10-082 Olsztyn, Poland. Tel.: +48 698 802 948.
Pol. Ann. Med. 2023;30(2):87–90
Heminephrectomy is considered the method of choice in the treatment of symptomatic or poorly working moiety of a duplex kidney as well as in oncology.

The study aims to retrospectively analyze the laparoscopic approach to heminephrectomy (LHN) in comparison with the open approach (OHN).

Material and methods:
From 2011 to 2020, 28 heminephrectomies were performed in the Clinical Ward of Pediatric Surgery and Urology of the Regional Specialized Children’s Hospital in Olsztyn: 10 with the laparoscopic transperitoneal method (LHN), and 18 with the open method (OHN). The mean age was 37.4 months (1–197 months). In total, 20 patients were female, and 8 were male. Loss of function of the moiety was a prerequisite for surgery. Hydronephrosis, dysplasia of the moiety, and vesicoureteral reflux were the most prevalent in both groups. Data regarding patients were collected based on available medical documentation and retrospectively analyzed.

Results and discussion:
There was no significant difference between the LHN and OHN groups regarding mean operating time (157 vs 128 minutes; P = 0.226) and mean postoperative hospital stay (5.20 vs 6.53; P = 0.64). The refeeding time is comparable and not statistically significant (1.90 vs 1.83 days; P = 0.555). Postoperative analgesic intake was found to be significantly lower (10.4 vs 17.5 doses, P = 0.004).

Both open and laparoscopic approaches are safe and feasible in the pediatric population. Both are comparable in operative time, hospital stay and refeeding time. LHN displays a better cosmetic effect and requires significantly lesser analgesic use.

Jordan GH, Winslow BH. Laparoendoscopic upper pole partial nephrectomy with ureterectomy. J Urol. 1993;150(3):940–943.
Jayram G, Roberts J, Hernandez A, et al. Outcomes and fate of the remnant moiety following laparoscopic heminephrectomy for duplex kidney: A multicenter review. J Pediatr Urol. 2011;7(3):272–275.
Li M, Cheng L, Zhang H, et al. Laparoscopic and Robotic-Assisted Partial Nephrectomy: An Overview of Hot Issues. Urol Int. 2020;104(9–10):669–677.
Robinson BC, Snow BW, Cartwright PC, DeVries CR, Hamilton BD, Anderson JB. Comparison of laparoscopic versus open partial nephrectomy in a pediatric series. J Urol. 2003;169(2):638–640.
El-Ghoneimi A, Farhat W, Bolduc S, Bagli D, McLorie G, Khoury A. Retroperitoneal laparoscopic vs open partial nephroureterectomy in children. BJU Int. 2003;91(6):532–535.
Lee RS, Retik AB, Borer JG, Diamond DA, Peters CA. Pediatric retroperitoneal laparoscopic partial nephrectomy: Comparison with an age matched cohort of open surgery. J Urol. 2005;174(2):708–712.
Golebiewski A, Losin M, Murawski M, Komasara L, Czauderna P. Laparoscopic versus open upper pole heminephroureterectomy for the treatment of duplex kidneys in children. J Laparoendosc Adv Surg Tech. 2013;23(11):942–945.
Neheman A, Kord E, Strine AC, et al. Pediatric Partial Nephrectomy for Upper Urinary Tract Duplication Anomalies: A Comparison Between Different Surgical Approaches and Techniques. Urology. 2019;125:196–201.
Dingemann C, Petersen C, Kuebler JF, Ure BM, Lacher M. Laparoscopic transperitoneal heminephrectomy for duplex kidney in infants and children: A comparative study. J Laparoendosc Adv Surg Tech. 2013;23(10):889–893.
Malik RD, Pariser JJ, Gundeti MS. Outcomes in pediatric robot-assisted laparoscopic heminephrectomy compared with contemporary open and laparoscopic series. J Endourol. 2015;29(12):1346–1352.
Zhou H, Ming S, Ma L, et al. Transumbilical single-incision laparoscopic versus conventional laparoscopic upper pole heminephroureterectomy for children with duplex kidney: A retrospective comparative study. Urology. 2014;84(5):1199–1204.
Yee DS, Shanberg AM. Robotic-assisted laparoscopic ureteroureterostomy in an adolescent with an obstructed upper pole system and crossed renal ectopia with fusion. Urology. 2006;68(3):673.e5–673.e7.
Jeon HG, Kim DS, Jeoung HB, et al. Pediatric laparoendoscopic single-site partial nephrectomy: Initial report. Urology. 2010;76(1):138–141.
Esposito C, Escolino M, Castagnetti M, et al. Retroperitoneal and laparoscopic heminephrectomy in duplex kidney in infants and children. Transl Pediatr. 2016;5(4):245–250.
Joyeux L, Lacreuse I, Schneider A, et al. Long-term functional renal outcomes after retroperitoneoscopic upper pole heminephrectomy for duplex kidney in children: a multicenter cohort study. Surg Endosc. 2017;31(3):1241–1249.
Polok M, Dzielendziak A, Apoznanski W, Patkowski D. Laparoscopic heminephrectomy for duplex kidney in children-the learning curve. Front Pediatr. 2019;7:117.
García-Aparicio L, Krauel L, Tarrado X, et al. Heminephroureterectomy for duplex kidney: Laparoscopy versus open surgery. J Pediatr Urol. 2010;6(2):157–160.
Choi JM, Bayne AP, Bian SX, Roth DR, Cisek LJ. A single-center experience with prone retroperitoneoscopic versus open renal surgery in children: An age- and procedure-matched comparison. J Endourol. 2011;25(9):1563–1572.
Till H, Basharkhah A, Hock A. What’s the best minimal invasive approach to pediatric nephrectomy and heminephrectomy: Conventional laparoscopy (CL), single-site (LESS) or robotics (RAS)? Transl Pediatr. 2016;5(4):240–244.