When Your Child Needs Laparoscopic Urologic Surgery

The doctor has advised laparoscopic urologic surgery for your child. This is to help diagnose or treat a problem in the urinary tract. Laparoscopic surgery uses smaller cuts (incisions) than traditional open surgery. This means that your child is likely to have less pain and a faster recovery. 

What are the benefits of laparoscopy?

Laparoscopy is a type of surgery that uses a long, thin, tube with a camera and light (laparoscope). The scope lets the surgeon see and operate inside the belly (abdomen). Small surgical tools are also used. With laparoscopy you can often expect:

• A short hospital stay. (Your child may even be able to go home the same day.)

• A faster recovery than with open surgery.

• Smaller scars on the skin.

• Less pain after the procedure.

How do we get ready for the procedure?

• Talk with your child's doctor about surgery, recovery, and pain management.

• Tell the surgeon about any medicines your child takes. Include herbs, vitamins, and both prescription and over-the-counter medicines. You may need to have your child stop taking certain medicines, such as ibuprofen, before the surgery.

• Discuss with the surgeon any allergies and health problems your child has. To make sure that your child is healthy and ready for surgery, the surgeon will:

  • Check your child's height, weight, and vital signs.

  • Ask about your child's health. If your child is sick, the surgery might be postponed until your child is better.

  • Do a physical exam on your child.

  • Look at the reports of the previous tests done and ask for any other tests that may be needed.

• Follow any directions your child is given about not eating or drinking before surgery. If you don't follow the directions, the surgery may have to be delayed.

• Meet with the anesthesiologist or nurse anesthetist before the surgery. They give your child medicine so your child sleeps and doesn't feel pain during the surgery. They'll also check your child’s heart rate, blood pressure, and oxygen levels during the surgery. Before surgery, they will talk with you about:

  • The type of anesthesia that will be used, how it will be given, and possible side effects.

  • Your child’s health and your family’s medical history for asthma or allergies, including whether your child or any family members have had anesthesia and any problems with it in the past.

  • Any medicines your child takes.

  • Any lab tests that may be needed to assess your child's fitness for the surgery. These may include blood or urine tests.

  • Instructions about how your child should prepare for surgery.

• You will have to sign admission papers and consent forms for your child's surgery and anesthesia.

What happens before the procedure?

You can help your child feel safe and secure. Bring a favorite toy, stuffed animal, or blanket. Give your child a hug and kiss. Remind your child that you will be there as soon as they wake up.

Your child will be given a mild sedative to help them relax. When it’s time for the procedure, your child will be given medicine to help them sleep through the surgery (general anesthesia). A soft, plastic tube (catheter) may be put into the bladder to drain urine during or after surgery.

What happens during the procedure?

The laparoscope lets the surgeon see inside your child’s pelvis. This helps him or her determine the cause of your child’s urologic problem.

After your child is asleep, the laparoscope is passed through a small cut made in the belly. The surgeon uses a small camera on the scope to see images on a video screen. Gas is used to inflate the belly to make room for the surgeon to see and work. Surgical tools are put through the other small cuts when needed. Depending on what the surgeon finds, they may be able to treat the problem at this time. In some cases, a surgical robot helps with the surgery. When the surgery is over, the gas is let out of your child's belly. The incisions are closed with stitches or clips, and a dressing is placed on top.

What happens after the procedure?

• Your child will be taken to a recovery room to wake up from anesthesia. You may be able to join your child at this time. Often, children waking up from anesthesia can cry a lot and be confused. This is very common.

• Nurses will care for and watch your child during recovery.

• Your child may feel some shoulder pain. This is from the gas used to inflate the belly.

• Your child may feel some pain at the incision sites. Medicine will be given to ease any pain.

• If a catheter was placed in the bladder, it may be removed before your child goes home.

• If you want to hold your child, ask the nurses to help you. They will show you how to hold your child comfortably while being careful of the equipment.

• The doctor will tell you when it’s safe for your child to leave the hospital.

Follow-up care

You will receive discharge directions when it’s time for your child to leave the hospital. Follow these carefully. Make a follow-up appointment with the doctor within the next  2 to 6 weeks. Your child’s condition and future care will be discussed at that appointment. 

When to call the doctor

Contact your child’s doctor right away if:

• Your child has a fever. (See "Fever and children" below.)

• Your child has chills.

• The incision site is red, swollen, draining, or bleeding.

• The incision site has a bad odor.

• There's more swelling at the incision site.

• Your child has severe belly pain or bloating.

• Your child has nausea or vomiting.

• Your child refuses to eat.

• Your child has pain that doesn’t go away or that gets worse with prescribed medicine.

• Your child is short of breath or has trouble breathing.

• Your child has numbness, tingling, or pain in the lower leg.

If your child is going home with tubes or drains, call if they aren't working correctly or come out, or if your child has a fever.

Fever and children

Use a digital thermometer to check your child’s temperature. Don’t use a mercury thermometer. There are different kinds of digital thermometers. They include ones for the mouth, ear, forehead (temporal), rectum, or armpit. Ear temperatures aren’t accurate before 6 months of age. Don’t take an oral temperature until your child is at least 4 years old.

Use a rectal thermometer with care. It may accidentally poke a hole in the rectum. It may pass on germs from the stool. Follow the product maker’s directions for correct use. If you don’t feel okay using a rectal thermometer, use another type. When you talk to your child’s doctor, tell them which type you used.

Below are some guidelines for when to call the doctor when your child has a fever. Your child’s doctor may give you different numbers for your child.

A baby under 3 months old:

• First, ask your child’s doctor how you should take the temperature.

• Rectal or forehead: 100.4°F (38°C) or higher

• Armpit: 99°F (37.2°C) or higher

A child age 3 months to 36 months (3 years):

• Rectal, forehead, or ear: 102°F (38.9°C) or higher

• Armpit: 101°F (38.3°C) or higher

Contact the doctor if your child:

• Has a repeated temperature of 104°F (40°C) or higher.

• Has a fever that lasts more than 24 hours (in a child under age 2).

• Has a fever that lasts for 3 days (in a child age 2 or older).

• Looks very sick, is drowsy, has other symptoms, has a weak immune system or other health issues, has a seizure, or is getting worse or no better.

How to help children cope with surgery

Many hospitals have staff trained in helping children cope with their hospital experience. This person is often a child life specialist. Ask your child’s doctor for more information about this service. There are also things you can do to help your child prepare for the procedure. The best way to do this depends on your child’s needs. Start with the tips below:

• Use short and simple terms to describe the procedure to your child and why it’s being done. Younger children tend to have a short attention span, so do this shortly before the surgery. Older children can be given more time to understand the procedure in advance.

• Make sure your child understands which body parts will be involved in the procedure.

• As best you can, describe how receiving anesthesia will feel. For instance, the medicine may be given as gas that comes out of a mask. The gas may smell like bubble gum or another flavor. It will make your child sleepy, so they nap during the surgery.

• Tell your child what they will likely see in the operating room during the surgery. For instance, you could mention who will be there or that the person giving your child medicine to help your child nap will be in uniform.

• Allow your child to ask questions, and answer these questions truthfully. Your child may feel nervous or afraid. They may even cry. Let your child know that you’ll be nearby during the procedure.

• Use play, if appropriate. With younger children, this can include role-playing with a child’s favorite toy or object. With older children, it may help to read books about what happens during the procedure.