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Laparoscopic Nephrectomy for Wilms Tumor in a One-Year Old Girl

From the APSA 2011 Annual Meeting

LAPAROSCOPIC NEPHRECTOMY FOR WILMS TUMOR IN A ONE YEAR OL D GIRL

Authors:

  • Guido Seitz, MD
  • Steven W. Warmann, MD
  • Martin Ebinger, MD
  • Falko Fend, MD
  • Jrg Fuchs, MD
  • University Children`s Hospital, Tuebingen, Germany,
  • University Hospital, Department of Pathology, Tuebingen, Germany

Purpose
To demonstrate the technique of a simultaneous laparoscopic nephrectomy of the left kidney and tru-cut biopsy on the right kidney for suspected bilateral Wilms tumor in a one year old girl.

Methods
Preoperative work-up revealed a large left sided Wilms tumor. In the contralateral kidney MRI revealed a suspicious alteration of the upper pole. Preoperative chemotherapy was administered according to the SIOP2001/GPOH protocol. Decision was taken to perform a laparoscopic nephrectomy on the left side and a laparoscopic biopsy of the right kidney. The patient was placed in supine position. One 5 mm and two 3 mm ports were placed. The tumor was completely mobilized using the harmonic knife. The renal artery and vein were ligated and transected with the harmonic scalpel. The tumor was removed via a Pfannenstiel`s incision because of its large size. A laparoscopically guided tru-cut biopsy of the upper pole was performed on the right kidney. Lymph node sampling was performed from all relevant levels.

Results
A complete tumor resection without microscopic residuals was achieved. The post-operative course was uneventful. Histological work up revealed nephroblastoma of intermediate risk (stromal subtype without anaplasia) on the left side and nephroblastomatosis on the right side. All lymph nodes were tumor free. Postoperative chemotherapy was continued.

Conclusions
Laparoscopic tumor nephrectomy is feasible even in young children suffering from nephroblastoma; however, a cautious selection of patients is essential. Intraoperative tumor spillage should be avoided in any case.


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