Hand-assisted laparoscopic surgery for Wilms tumor in a child: A case report

Hand-assisted laparoscopic surgery (HALS) is a technique that uses a device that allows the surgeon to insert a hand into the abdomen while maintaining the pneumoperitoneum. While there are a few reports of HALS in pediatric patients with benign diseases, there are no documented cases in pediatric oncology. A 13-year-old girl presented with the onset of left-sided abdominal pain. An abdominal ultrasound (US) revealed a mass in the left kidney. A magnetic resonance (MRI) of the abdomen and a total-body computerized tomography (CT) scan confirmed the presence of a 10-cm left renal mass without evidence of metastatic lesions. Following the UMBRELLA SIOP-RTSG 2016 protocol, the patient underwent preoperative chemotherapy, after which a follow-up MRI showed a reduction in the mass size to 7 cm. We subsequently proceeded with a hand-assisted laparoscopic left nephrectomy. A GelPort® (Applied Medical, Rancho Santa Margarita, CA, USA) was inserted through a 6-cm Pfannenstiel incision. Two additional 5-mm and 10-mm trocars were added in the left upper quadrant and the umbilicus. During the operation, a neoplastic infiltration was seen on the diaphragm, which had not been seen on MRI. A portion of the diaphragm was resected, and the defect was repaired using an interrupted resorbable suture. Eight lymph nodes were sampled from the hilar, supra-hiliar, infra-hiliar, paraaortic, and inter-aortocaval areas. Pathological examination confirmed a blastemal-predominant Wilms tumor, negative lymph nodes, and a positive diaphragmatic infiltrate. The postoperative course was uneventful, and the patient was discharged on the third postoperative day. She received the postoperative chemotherapy regimen indicated by the protocol. At a follow up of 41 months she has no recurrence. Hand-assisted laparoscopic surgery appears to be a safe and effective approach for the resection of solid renal tumors requiring total nephrectomy, potentially reducing the risk of tumor spillage and bleeding.