Minimally Invasive Uro-Oncology

  • Nicholas G. Cost
  • Paul H. Noh


Despite advances in minimally invasive surgery and the increasing adoption of such techniques in pediatric urology, there remains a paucity of data or evidence-based recommendations for its use for pediatric or adolescent urologic oncology. However, there are a number of malignancies managed by urologic surgeons which have surgical indications that may be reasonably approached by minimally invasive surgery. There exist published reports of various adrenal (neuroblastoma), renal (Wilms tumor and renal cell carcinoma), testicular (germ cell tumor), and paratesticular (rhabdomyosarcoma) malignancies in children which have been managed with laparoscopy or robotic-assisted laparoscopy. Also, childhood prostate and bladder tumors, such as rhabdomyosarcoma, are routinely approached initially by endoscopy. The history of endoscopy and laparoscopy in pediatric urologic oncology provides a foundation for its current indications. In this chapter we will review the surgical techniques (including patient positioning, port placement, and selection of surgical instrumentation) and suggestions for approaching pediatric and adolescent urologic malignancies with minimally invasive surgery.

Additionally, we will review potential complications and critically discuss the controversy surrounding its use.


Pediatric Adolescent Cancer Oncology Malignancy Urologic Surgical Minimally invasive Laparoscopy Endoscopy 



Children’s Oncology Group


Image-Defined Risk Factors


Inflammatory Myofibroblastic Tumors


International Pediatric Endosurgery Group




Inferior Vena Cava


Lymph Node


Minimally Invasive Surgery


Nephron-Sparing Surgery


Paratesticular Rhabdomyosarcoma


Renal Cell Carcinoma




Radical Nephrectomy


Retroperitoneal Lymph Node Dissection


International Society of Pediatric Oncology


Testicular Germ Cell Tumors


Transurethral Resection


Wilms Tumor

Supplementary material

115791_2_En_31_MOESM1_ESM.vob (1023.8 mb)
VTS_01_1 (VOB 0.99 GB)


  1. 1.
    Gans SL, Berci G. Advances in endoscopy of infants and children. J Pediatr Surg. 1971;6(2):199–233.PubMedCrossRefGoogle Scholar
  2. 2.
    Rodgers BM, Talbert JL. Thoracoscopy for diagnosis of intrathoracic lesions in children. J Pediatr Surg. 1976;11(5):703–8.PubMedCrossRefGoogle Scholar
  3. 3.
    Holcomb 3rd GW, Tomita SS, Haase GM, Dillon PW, Newman KD, Applebaum H, et al. Minimally invasive surgery in children with cancer. Cancer. 1995;76(1):121–8.PubMedCrossRefGoogle Scholar
  4. 4.
    Duarte RJ, Denes FT, Cristofani LM, Odone-Filho V, Srougi M. Further experience with laparoscopic nephrectomy for Wilms’ tumour after chemotherapy. BJU Int. 2006;98(1):155–9.PubMedCrossRefGoogle Scholar
  5. 5.
    Barber TD, Wickiser JE, Wilcox DT, Baker LA. Prechemotherapy laparoscopic nephrectomy for Wilms’ tumor. J Pediatr Urol. 2009;5(5):416–9.PubMedCrossRefGoogle Scholar
  6. 6.
    Javid PJ, Lendvay TS, Acierno S, Gow KW. Laparoscopic nephroureterectomy for Wilms’ tumor: oncologic considerations. J Pediatr Surg. 2011;46(5):978–82.PubMedCrossRefGoogle Scholar
  7. 7.
    Rauth TP, Slone J, Crane G, Correa H, Friedman DL, Lovvorn 3rd HN. Laparoscopic nephron-sparing resection of synchronous Wilms tumors in a case of hyperplastic perilobar nephroblastomatosis. J Pediatr Surg. 2011;46(5):983–8.PubMedCentralPubMedCrossRefGoogle Scholar
  8. 8.
    Cost NG, Geller JI, Defoor Jr WR, Wagner LM, Noh PH. A robotic-assisted laparoscopic approach for pediatric renal cell carcinoma allows for both nephron-sparing surgery and extended lymph node dissection. J Pediatr Surg. 2012;47(10):1946–50.PubMedCrossRefGoogle Scholar
  9. 9.
    Piche N, Barrieras D. Minimally invasive nephron-sparing surgery for unilateral Wilms tumor. J Pediatr Surg. 2012;47(7):e1–4.PubMedCrossRefGoogle Scholar
  10. 10.
    Heloury Y, Muthucumaru M, Panabokke G, Cheng W, Kimber C, Leclair MD. Minimally invasive adrenalectomy in children. J Pediatr Surg. 2012;47(2):415–21.PubMedCrossRefGoogle Scholar
  11. 11.
    Tomaszewski JJ, Sweeney DD, Kavoussi LR, Ost MC. Laparoscopic retroperitoneal lymph node dissection for high-risk pediatric patients with paratesticular rhabdomyosarcoma. J Endourol. 2010;24(1):31–4.PubMedCrossRefGoogle Scholar
  12. 12.
    Cost NG, DaJusta DG, Granberg CF, Cooksey RM, Laborde CE, Wickiser JE, et al. Robot-assisted laparoscopic retroperitoneal lymph node dissection in an adolescent population. J Endourol. 2012;26(6):635–40.PubMedCrossRefGoogle Scholar
  13. 13.
    Hafez AT, Sarhan M, Sarhan O, El-Sherbiny MT, Ghoneim MA. Chemotherapy as monotherapy for treatment of non-metastatic bladder/prostate embryonal rhabdomyosarcoma in children: preliminary report. J Pediatr Urol. 2006;2(1):23–30.PubMedCrossRefGoogle Scholar
  14. 14.
    Ontario Ministry of Health and Long-Term Care. Robotic-assisted minimally invasive surgery for gynecologic and urologic oncology: an evidence-based analysis. Ont Health Technol Assess Ser. 2010;10(27):1–118.Google Scholar
  15. 15.
    de Lijster MS, Bergevoet RM, van Dalen EC, Michiels EM, Caron HN, Kremer LC, et al. Minimally invasive surgery versus open surgery for the treatment of solid abdominal and thoracic neoplasms in children. Cochrane Database Syst Rev. 2012;1:CD008403.PubMedGoogle Scholar
  16. 16.
    International Pediatric Endosurgery Group. IPEG guidelines for the surgical treatment of adrenal masses in children. J Laparoendosc Adv Surg Tech A. 2010;20(2):vii–ix.Google Scholar
  17. 17.
    Ludwig AD, Feig DI, Brandt ML, Hicks MJ, Fitch ME, Cass DL. Recent advances in the diagnosis and treatment of pheochromocytoma in children. Am J Surg. 2007;194(6):792–6; discussion 6–7.PubMedCrossRefGoogle Scholar
  18. 18.
    Castilho LN, Castillo OA, Denes FT, Mitre AI, Arap S. Laparoscopic adrenal surgery in children. J Urol. 2002;168(1):221–4.PubMedCrossRefGoogle Scholar
  19. 19.
    Duarte RJ, Denes FT, Cristofani LM, Giron AM, Filho VO, Arap S. Laparoscopic nephrectomy for Wilms tumor after chemotherapy: initial experience. J Urol. 2004;172(4 Pt 1):1438–40.PubMedCrossRefGoogle Scholar
  20. 20.
    Chui CH, Lee AC. Peritoneal metastases after laparoscopic nephron-sparing surgery for localized Wilms tumor. J Pediatr Surg. 2011;46(3):e19–21.PubMedCrossRefGoogle Scholar
  21. 21.
    Cost NG, Cost CR, Geller JI, Defoor WR, Jr. Adolescent urologic oncology: current issues and future directions. Urol Oncol. 2012 Pub Med:23141778.Google Scholar
  22. 22.
    NCCN. Clinical practice guidelines in oncology: testicular cancer. Nat Compr Cancer Netw. 2012;10:502–35; v.1.2012.Google Scholar
  23. 23.
    Davol P, Sumfest J, Rukstalis D. Robotic-assisted laparoscopic retroperitoneal lymph node dissection. Urology. 2006;67(1):199.PubMedCrossRefGoogle Scholar
  24. 24.
    Grimsby GM, Ritchey ML. Pediatric urologic oncology. Pediatr Clin North Am. 2012;59(4):947–59.PubMedCrossRefGoogle Scholar
  25. 25.
    Korrect GS, Minevich EA, Sivan B. High-grade transitional cell carcinoma of the pediatric bladder. J Pediatr Urol. 2012;8(3):e36–8.PubMedCrossRefGoogle Scholar
  26. 26.
    Berger A, Kim C, Hagstrom N, Ferrer F. Successful preoperative treatment of pediatric bladder inflammatory myofibroblastic tumor with anti-inflammatory therapy. Urology. 2007;70(2):372.e13–5.CrossRefGoogle Scholar
  27. 27.
    Gordetsky J, Katzman P, Rashid H. Juxtarenal Wilms tumor in an adolescent. Urology. 2012;80(4):922–4.PubMedCrossRefGoogle Scholar
  28. 28.
    Iwanaka T, Arai M, Kawashima H, Kudou S, Fujishiro J, Imaizumi S, et al. Endosurgical procedures for pediatric solid tumors. Pediatr Surg Int. 2004;20(1):39–42.PubMedCrossRefGoogle Scholar
  29. 29.
    Mucksavage P, McDougall EM, Clayman RV. Laparoscopic transperitoneal nephrectomy for renal cancer: the University of California, Irvine, technique. J Endourol. 2011;25(2):195–200.PubMedCrossRefGoogle Scholar
  30. 30.
    Shanberg AM, Perer E, Matsunaga G. Re: laparoscopic nephrectomy for Wilms tumor after chemotherapy: initial experience. J Urol. 2006;175(2):788.PubMedCrossRefGoogle Scholar
  31. 31.
    Ryu KH, Im CM, Kim MK, Kwon D, Park K, Ryu SB, et al. Inflammatory myofibroblastic tumor of the kidney misdiagnosed as renal cell carcinoma. J Korean Med Sci. 2010;25(2):330–2.PubMedCentralPubMedCrossRefGoogle Scholar
  32. 32.
    Barber TD, Derinkuyu BE, Wickiser J, Joglar J, Koral K, Baker LA. Wilms tumor: preoperative risk factors identified for intraoperative tumor spill. J Urol. 2011;185(4):1414–8.PubMedCrossRefGoogle Scholar
  33. 33.
    Benway BM, Cabello JM, Figenshau RS, Bhayani SB. Sliding-clip renorrhaphy provides superior closing tension during robot-assisted partial nephrectomy. J Endourol. 2010;24(4):605–8.PubMedCrossRefGoogle Scholar
  34. 34.
    Shamberger RC, Guthrie KA, Ritchey ML, Haase GM, Takashima J, Beckwith JB, et al. Surgery-related factors and local recurrence of Wilms tumor in National Wilms Tumor Study 4. Ann Surg. 1999;229(2):292–7.PubMedCentralPubMedCrossRefGoogle Scholar
  35. 35.
    Raval MV, Bilimoria KY, Bentrem DJ, Stewart AK, Winchester DP, Ko CY, et al. Nodal evaluation in Wilms’ tumors: analysis of the national cancer data base. Ann Surg. 2010;251(3):559–65.PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag London 2014

Authors and Affiliations

  1. 1.Division of Urology Pediatric Urology and Urologic Oncology, Department of SurgeryUniversity of Colorado Anschutz Medical Campus, Children’s Hospital Colorado and University of Colorado HospitalAuroraUSA
  2. 2.Minimally Invasive Surgery, Division of Pediatric UrologyCincinnati Children’s Hospital Medical CenterCincinnatiUSA

Personalised recommendations