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Laparoscopic nephrectomy can be performed from the front (transperitoneal) or from the back or side (retroperitoneal). Most kidneys can be removed using the retroperitoneal approach, which seems to permit even more rapid recovery. If the ureter (the tube connecting the kidney with the bladder) needs to also be removed, the transperitoneal approach is sometimes better.
When the kidney is to be removed laparoscopically, it is performed under general anesthesia and three or four punctures are used. The kidney is removed through one of the puncture sites, sometimes using a small bag inserted into the surgical area to allow the kidney to be pulled out.
The child is kept overnight in the hospital and discharged to home. There is no further need for routine/serial surveillance. The risk of hypertension or tumor arising from this kidney is eliminated. Many parents have elected this form of treatment since it puts closure on the issue. The other indications for surgery include a very large multicystic kidney that may cause difficulty with feeding or breathing due to its large size. It should be mentioned that this is a congenitally developed lesion and is not related to the adult condition known as adult polycystic kidney disease. For more information on laparoscopic nephrectomy see Minimally Invasive Surgery (Genitourinary).
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