Minimally invasive interventions for kidney duplication in children

Duplication of the kidneys and ureters is one of the most common malformations of the kidneys and urinary tract in children. Surgery for kidney duplication is recommended in the case of the course of the disease with clinical manifestations. Currently, indications for partial nephrectomy include a non-functioning kidney fragment with recurrent urinary tract infections, urinary incontinence due to ectopic ureter or vesicorenal reflux with the development of lower kidney hydronephrosis. Heminephrectomy is the «gold standard» of treatment for clinically apparent kidney duplication. Other surgical interventions, such as ureteropyelostomy, ureteroureterostomy require an elective approach and are unsafe for a healthy segment of the kidney. A minimally invasive approach to treatment for kidney duplication is represented by transperitoneal laparoscopy, retroperitoneoscopy, single-port and robot-assisted surgery. These innovative methods help to reduce the need for postoperative analgesia, a shorter stay of patients in the hospital, less blood loss, while demonstrating safety. The choice of technology should be determined in accordance with the age of the patient, technical capabilities and personal experience of the surgeon. The advantages and disadvantages of new treatments for kidney duplication regularly become the subject of much discussion. Undoubtedly, high costs, as well as a more complex technique compared to the classical open technique, are cited as disadvantages of minimally invasive heminephrectomy. Among the advantages of the method are a reduction of terms of inpatient stay, a reduction in the period of postoperative pain, a better cosmetic effect, and a quick return to full physical activity in a child, which were established in numerous studies presented in this literature review.