Dr. A.K. Singal MBBS (Gold Medalist), DNB, MNAMS
M.CH (AIIMS, Gold Medalist)
Stecker Scholar Pediatric Urology (USA)

Index Cases

A child with Multicystic Kidney disease

Master R.S., a 3 years old boy was referred to Pediatric urology clinic from Pune, Maharahstra with swelling on the left side of his belly for last 6 months. The antenatal USG of the child had shown some kidney issue but the parents were not told to follow up with a pediatric urologist after birth.

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 Multicystic kidney had been diagnosed before birth and was on follow-up without surgery but over the recent times the kidney had started becoming bigger.

Since the multicystic kidney had not undergone a natural resolution and was getting bigger- we planned to remove it to prevent further complications. The child underwent Laparoscopic Left Nephrectomy surgery (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 for multicystic kidney in a child 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 less painful way of doing surgery 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 kidney surgery in children, Pediatric Urologist doctors in India are well trained to do these surgeries by laparoscopy.

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 nephrectomy surgery if indicated.

Dr A.K.Singal is an expert pediatric urological surgeon and performs major kidney surgeries by using laparoscopic technique in children. He is available in various hospitals in Thane, Navi Mumbai and Mumbai. Children from Mumbai, Pune, Nagpur, Thane, Navi Mumbai, Nasik, Ahmedabad, Surat, Vadodara, Hyderabad, Bangalore, Delhi, Kolkata and many more cities in India come to seek treatment under his care in Mitr Hospital at Kharghar, India.

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