eISSN: 2299-0054
ISSN: 1895-4588
Videosurgery and Other Miniinvasive Techniques
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vol. 18
Pediatric surgery
Original paper

Laparoscopic nephron-sparing surgery and laparoscopic nephrectomy for Wilms’ tumor

Maciej Murawski
Joanna Stefanowicz
2, 3, 4
Marcin Łosin
Andrzej Gołębiewski
Piotr Czauderna

Department of Surgery and Urology for Children and Adolescents, Faculty of Medicine, Medical University of Gdansk, Gdansk, Poland
Department of Pediatrics, Hematology and Oncology, Faculty of Medicine, Medical University of Gdansk, Gdansk, Poland
Department of Paediatrics, Haematology and Oncology, Clinical University Centre, Gdansk, Poland
Faculty of Health Sciences, Medical University of Gdansk, Gdansk, Poland
Videosurgery Miniinv 2023; 18 (2): 358–363
Online publish date: 2022/12/17
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The place of laparoscopy in the resection of Wilms’ tumors has remained debatable, but evidence that neoadjuvant chemotherapy causes tumor shrinkage has made laparoscopic nephrectomy (LN) a feasible option. Laparoscopic nephron-sparing surgery (NSS) is technically very demanding and seems to be feasible and effective only when performed by a very experienced surgeon. Aim: We report 7 cases of laparoscopic nephrectomy and 1 case of laparoscopic heminephrectomy for Wilms’ tumor.

Material and methods
Forty-two consecutive children with primary renal tumor underwent nephrectomy between 2013 and 2020; 11 had an LN. Among them there were 8 children with Wilms’ tumor, with age between 13 months and 7 years. All patients received neoadjuvant chemotherapy according to the current SIOP protocol. The mean tumor volume before and after chemotherapy was 174.4 ml (range: 14.7–501) and 32.8 ml (range: 4.3–68) respectively.

Seven laparoscopic nephrectomies and one heminephrectomy were performed. No patient had an intraoperative tumor rupture. All children had an attempt of lymph node sampling (their number per pathology assessment was in the range 0–5). There were no intraoperative events. One complication after heminephrectomy occurred, which was urine leak. Five patients had stage I tumor and 3 had stage II. Seven patients had an intermediate-risk and one had a high-risk tumor. There were no local or distant relapses. All patients remained disease-free at a median follow-up of 71 months (range: 16–94).

This report demonstrates the feasibility of LN in children with Wilms’ tumors. The patients should be carefully selected and specific training in laparoscopy is necessary, particularly with regard to laparoscopic heminephrectomy.


laparoscopy, nephron-sparing surgery, Wilms’ tumor

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