Laparoscopy in pediatric urology

Purpose of review: Laparoscopic surgery in pediatric urology is beginning to accelerate in its application and this has been reflected in increasing series of progressively more complex procedures. To review these, and assess the character of this evolution, articles dealing with diagnostic and operative laparoscopic surgery from mid 2002 to late 2003 have been reviewed. Recent findings: Several important trends can be seen, including the emergence of increasing numbers of multi-center studies, comparative assessments between properly matched open procedures, as well as comparisons between various laparoscopic techniques. The role of diagnostic laparoscopy in cryptorchidism seems well established, although attempts at being more selective in its application have been published. Operative procedures are being performed to include not only simple removal of tissues, but also reconstructive procedures such as pyeloplasty in more than anecdotal numbers. A strong emphasis has been placed on retroperitoneal access, which is inherently more attractive, but the challenges of this technique are evident. Ultimately it should become more efficient with experience. Summary: There has been a steady and progressively more widespread application of laparoscopic techniques in pediatric urology, which has been somewhat slow to develop compared with adult laparoscopy. It seems likely that this progression will continue to accelerate.