Indications

The distinction between adult and pediatric urologic laparoscopy begins with divergent indications, reflecting the different patterns of urologic disease between adults and children. The need for laparoscopic procedures in pediatric urologic practice is different from adults, with some elements of overlap.

Most of the procedures being performed are based on an integration of diagnostic and operative laparoscopy for the undescended testis. Procedures involving extirpative surgery are almost always for benign disease of congenital origin. Overlap is emerging, mostly in areas of reconstructive urology. While these differences may discourage sharing of experience, the basic principles are similar and the adult urologist with significant laparoscopic experience can facilitate the development of their pediatric colleagues' laparoscopic expertise. Similarly, the pediatric urologist can bring experience with delicate reconstruction to the adult arena.

As the potential for reconstructive pediatric laparoscopy has emerged, it has been evident that the dispersion of laparoscopic skills into complex reconstruction by pedi-atric urologists has been limited.

The reasons for this are multiple but may largely stem from different practice patterns among adult and pediatric urologists that have limited the number of surgeons willing and able to climb the learning curve for reconstructive work.

The pediatric urologist's practice patterns pose a challenge to the development of laparoscopic skills and experience in that even with a busy practice the fraction of cases that may ever be performed laparoscopically will remain limited. In academic departments, there might be surgeons performing only one or two operations in adult practice, while in pediatric groups nearly all will routinely perform up to 20 different types of procedures from hypospadias to pyeloplasty.

The ability to gain sufficient case numbers to become expert at complex laparoscopy in a reasonable period of time will be difficult and the collaboration of adult and pediatric surgeons will be important to permit development of these skills in the pediatric realm.

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