A child with Multicystic Kidney disease
Master R.S., a 3 years old boy was brought from Pune, Maharahstra with swelling on the left side of his belly for last 6 months.
Clinically, the swelling seemed to be from the left kidney and ultrasonogram (USG) showed it to be a Multicystic Kidney - abnormal nonfunctioning kidney composed of a bunch of cysts. This has been diagnosed before birth and was on followup without surgery but over the recent times the kidney had started becoming bigger.
Since the multicystic kidney had not undergone a natural resolution and as such was getting bigger- we planned to remove it to prevent further complications. The child underwent Laparoscopic Left Nephrectomy (Removal of the kidney). He recovered well and was discharged on day 1 of surgery.
Clinical picture showing swelling Clinical picture of multicystic kidney
Multicystic Kidney and Laparoscopic Nephrectomy
Multicystic Kidney disease (MCKD) is a congenital malformation where by the kidney is developmentally abnormal and non-functioning. It looks like a bunch of grapes. Most of the times, MCKD does not require any therapy other than confirming the diagnosis and differentiating it from severe hydronephrosis by a USG and a renal scan. 80% of these kidneys gradually become smaller and disappear by 4-5 years of age. Surgery is indicated only when there is a persistent MCKD or there is a large lump interfering with growth of the baby.
Pediatric Laparoscopy or laparoscopic surgery in children is a new and upcoming specialty and it has been possible due to availability of miniaturized equipment, small telescopes and above all well trained doctors. The concept of laparoscopy in children is very appealing and is being applied to more and more surgical problems in kids.
For laparoscopy, initially a small hole is made in the belly button or navel to put a telescope and also to infuse a harmless gas (generally carbon dioxide) into the belly. This inflates the belly and gives working space to the surgeon. Then through small holes, instruments are put to perform the procedure. These instruments for kids are really small—the tip size is just 3 mm. A camera is attached to the telescope and is used to watch the procedure on a monitor in a magnified and more precise way. At the end of the surgery, the instruments are removed from the belly and one or two stitches are put within the skin to finish the procedure. These stitches need not be removed. It is amazing how extensive procedures can be performed with 3-4 key hole punctures
MCKD and other non-functioning kidneys if required to be removed are best suited for removal by Laparoscopic surgery if indicated.
 Dr A.K.Singal is an expert pediatirc urological surgeon and does major kidney surgery by using laparoscopic technique in children. He is available in various hospitals in Thane, Navi Mumbai and Mumbai. 


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