Oncology

Very little laparoscopic work has been performed in any pediatric oncologic applications, yet there should be the potential for such application in the future. For the common neoplasms, however, there will likely be substantial limitations due to the frequent large size of pediatric tumors, particularly Wilms' and neuroblastoma. Adrenal tumors have been resected laparoscopically with good results in children, usually neuroblastoma (1-3). Genital tumors such as gonadoblastoma have been resected laparoscopically, although often when occult in dysgenetic gonads (4). There is likely a role for laparoscopy as more screening programs directed toward at-risk populations for neuroblastoma or Wilms' tumor in which small volume tumors may be more often detected. Diagnostic or staging applications may also see some development as well. This might be particularly suitable for contralateral exploration of the kidney in Wilms' tumor or in prechemother-apy biopsy to permit more accurate diagnosis and staging.

The evolution of pediatric urologic laparoscopy will continue at perhaps a slower pace than that in adult urology, but it should continue to do so. Much of the current work is being carried out by pediatric surgeons who also perform a variety of intra-abdominal laparoscopic procedures and thereby can develop their skills and experience more rapidly. This may limit the role the pediatric urologists play in the overall development of this field and active participation should be encouraged.

0 0

Post a comment