Pareek G et al. (2008) Laparoscopic and robotic urology: laparoscopic renal surgery in the octogenarian. BJU Int 101: 867–870

Neheman A (2008) Laparoscopic urinary tract surgery in infants weighing 6 kg or less: perioperative considerations and comparison to open surgery. J Urol 179: 1534–1538

Laparoscopic procedures are generally considered to provide good results compared with their open equivalents, but most published studies have included only patients with favorable characteristics. However, the indications for laparoscopic surgery are gradually being broadened, and two new studies support the inclusion of especially vulnerable groups of patients—the very young and the elderly.

Pareek and colleagues describe good outcomes for 26 octogenarian patients who underwent laparoscopic treatment of a solid renal mass: partial (n = 3) or radical (n = 10) nephrectomy, nephroureterectomy (n = 4), cryoablation (n = 7), radiofrequency ablation (n = 1) and unroofing of a renal cyst (n = 1). These patients had multiple comorbidities and correspondingly increased surgical risks, but the complication rate was acceptable and operative characteristics were similar to those expected in favorable-risk populations. There were no treatment-related deaths. Of 22 patients who were alive at last follow-up (range 8–84 months), 19 had no evidence of disease.

Neheman et al. compared the outcomes of 17 newborn or small infants who underwent transperitoneal, laparoscopic, urinary tract surgery with those of a historical cohort of 18 infants matched for age, weight and BMI who underwent open procedures. All children weighed ≤6 kg. Despite the technical difficulty of performing laparoscopic surgery in such small infants, the groups had similar outcomes. These authors highlight the need for experienced surgeons and anesthesiologists to perform these procedures.