Kidney stones in children are rare. Therefore, doctors often have limited experience with minimally invasive surgeries in children of kindergarten age. Additionally, the small-sized and narrow anatomical conditions in toddlers further complicate matters. In percutaneous kidney operations, which involve a puncture or small incision under the skin, extremely precise work is required. For three-year-old Jakob from Hannover, this meant a long journey through several university hospitals and medical practices in Germany. It wasn't until he reached the Goldstadt Private Clinic in Pforzheim that a large kidney pelvic stone could be removed.

Pioneer of Miniaturized Percutaneous Kidney Stone Surgery

Due to the large kidney stone, little Jakob suffered from recurrent urinary tract infections. Possible treatment alternatives considered were extracorporeal shock wave lithotripsy (ESWL), percutaneous kidney puncture, or open surgery. However, treatment could not be performed anywhere due to limited experience with minimally invasive surgeries in children. But Jakob's parents continued to search for a urology specialist and came across Prof. Dr. med. Sven Lahme, the Medical Director of the Goldstadt Private Clinic in Pforzheim.

Back in 2001, Lahme had already designed a new surgical instrument with the support of the Knittlingen-based company Richard Wolf - the Miniature Nephroscope, whose extremely thin shaft cross-section could meet the requirements of a truly minimally invasive operation. Consequently, Lahme has extraordinary expertise in miniaturized percutaneous kidney stone surgery (Mini-PCNL), in which a puncture of the renal pelvis is performed from the back under ultrasound guidance.

Kidney Stone Fragmented with Laser

The access to the kidney is expanded to approximately five millimeters, and then a tube is inserted through the skin into the kidney. Through this tube, the urologist has access to the kidney stone. The stone is fragmented into dust-like particles under endoscopic view using the laser. These tiny stone fragments are suctioned out through the tube to the outside. At the end of the operation, the tube is removed, and the access to the kidney is practically no longer visible.

Coordinated Team and Assistance from Pediatric Anesthesiologist

The risk of complications during the procedure is significantly lower than with conventional surgical methods. But what makes mini-PCNL challenging in children? The procedure is performed under ultrasound guidance, which provides a clear view of the neighboring organs that must not be injured. In young children, all organs are in miniature size and are closely situated to each other. "In addition to the expertise of the surgeon, a coordinated operating room team consisting of specialized surgical nurses and anesthesiologists is essential," says Lahme, who has performed mini-PCNL procedures around 80 times with live surgical transmission to specialists in several countries.

Stone Completely Removed

The large stone was completely removed in a single surgical session using mini-PCNL. After a hospital stay of five days, Jakob was discharged home to Hannover. The outpatient follow-up examination three weeks after discharge was unremarkable. For Jakob, the operation marked the end of a long ordeal. His parents were overjoyed that they could stay with Jakob throughout his entire hospital stay.

Source: www.vital-region.de