Laparoscopic pyeloplasty: the first decade (original) (raw)
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Indian Journal of Surgery
UPJO causes hydronephrosis and progressive renal impairment may ensue if left uncorrected. Open pyeloplasty remains the standard against which new technique must be compared. We analyzed the comparison of Laparoscopic and open pyeloplasty in a randomized prospective trial. A prospective randomized study was done from January 2004 to January 2007 in which a total of 28 Laparoscopic and 34 open pyeloplasty were done. All laparoscopic pyeloplasties were performed transperitoneally. Standard open Anderson Hynes pyeloplasty, spiral flap or VY plasty was done depending on anatomic consideration. Patients were followed with DTPA scan at 3 months and IVP at 6 months. Perioperative parameters including operative time, analgesic use, hospital stay, and complication and success rates were compared. Mean total operative time with stent placement in LP group was 244.2 min (188–300 min) compared to 122 min (100–140 min) in open group. Compared to open pyeloplasty the post operative diclofenac requirement was significantly less in LP group (mean107.14 mg) and open group required mean of (682.35 mg) The duration of analgesic requirement was also significantly less in LP group. The post operative hospital stay in LP was mean 8.29 days (7–11) and was significantly less than open group (mean 3.14 Days (2–7 days). Open pyeloplasty has been the gold standard for UPJO repair and achieves success rates exceeding 90%. Laparoscopic pyeloplasty provides a minimally invasive alternative to repair UPJO and has developed world wide as the first minimally option to match success rate of open pyeloplasty. Its potential advantages including less post op pain, shorter hospital stay an improved cosmesis has been proved in some comparative series. The only disadvantage seems to be longer operative time. LP has a minimal level of morbidity and short hospital stay compared to open approach Although Laparoscopic pyeloplasty has the disadvantages of longer operative time and requires significant skill of intracorporeal knotting but it is here to stay and represents an emerging standard of care.
Laparoscopic Pyeloplasty, Our Experience of Initial Fifty Two Cases
Journal of Urological Surgery, 2020
Amaç: Minimal invaziv cerrahinin artan popularitesiyle birlikte, Laparoskopik Piyeloplasti ürologların temel aracı haline gelmiştir. Buna karşın cerrahi, dik bir öğrenme eğrisine ve daha uzun operasyon sürelerine sahiptir. Bu çalışmada, kliniğimizde laparoskopik parçalanmış piyeloplasti gerçekleştirilen ilk 52 olguya ait sonuçların değerlendirilmesi amaçlanmıştır. Gereç ve Yöntem: Pelvi-üreterik bileşke (PÜE) darlığına sahip, 30 erkek ve 22 kadın olmak üzere yaş ortalaması 23,5 olan toplam 52 hastaya transperitoneal laparoskopik parçalanmış pyeloplasti uygulandı. Hastalar tam lateral pozisyona yerleştirildi ve en az üç port kullanılarak ameliyat yapıldı, hepsinde retrograd piyelografi yapıldı; ilk erişimde Veress iğnesi kullanıldı. Üreter ilk olarak spatüle edildi; önce sütür alındı ve daha sonra üreterin dönüşünü önlemek için PUJ parçalandı. Antegrad DJ stentleme bütün hastalara uygulandı ve operasyon sonrası retroperitonda bir diren bırakıldı. Operasyondan 6 hafta sonra DJ stent çıkarıldı. Bulgular: Elli iki hasta parçalanmış piyeloplasti ile tedavi edildi. Altı hastaya ameliyat öncesi üriner diversiyon gerekti. Yedi hastada Intrarenal pelvis, 10 hastada damar geçişi, 6 hastada yüksek yerleşimli üreter ve 5 hastada ilişkili kalkül görülmüştür. Altı hastada açık cerrahiye dönülmesi gerekmiştir. Başlangıçta operasyon süresi 3 saatten daha uzunken, 25 olguda oluşan yeterli deneyim sonrası büyük ölçüde azalmıştır. Son 28 olgunun ortalama Öz Objective: With the increasing popularity of minimally-invasive surgery, laparoscopic pyeloplasty has become a staple in the armamentarium of urologists. However, the surgery has a steep learning curve and longer operative time. In this study, we aimed to evaluate the results of initial 53 cases of laparoscopic dismembered pyeloplasty in our institute. Materials and Methods: A total 52 of patients with pelvi-ureteric junction (PUJ) obstruction, 30 male and 22 female, with the mean age of 23.5 years were managed by transperitoneal laparoscopic dismembered pyeloplasty. The patients were placed in full lateral position and surgery was done using a minimum of three ports, retrograde pyelography was done in all; initial access was done by using a Veress needle. The ureter was spatulated first, first suture taken and then the PUJ was dismembered to avoid rotation of the ureter. Antegrade DJ stenting was done in all patients and one drain was left in the retroperitoneum after surgery. DJ stent was removed six weeks after surgery. Results: Fifty two patients were managed by dismembered pyeloplasty. Six patients required preoperative urinary diversion. Intrarenal pelvis was seen in seven, crossing vessel in ten, high insertion of ureter in six and associated calculus in five patients. Conversion to open surgery was required in six patients. Initially, the operative time was more than three hours but after sufficient experience of 25 cases, it reduced drastically and in last 28 cases, the mean operative time was 123 minutes, with shortest time reported 97 minutes. Reintervention was required in eight patients and overall success rate was 87%. Conclusion: Laparoscopic pyeloplasty is a safe, minimally-invasive and viable alternative to open pyeloplasty for the management of PUJ obstruction.
Laparoscopic pyeloplasty: current status
BJU International, 2005
28), Fenger plasty (11) and others (two) were used, according to the intraoperative findings. Twenty-five patients had secondary obstruction, having had previous surgery to the PUJ. The mean (range) follow-up was 24 (3-84) months; all patients were followed clinically and radiologically.
Outpatient laparoscopic pyeloplasty
Urology, 2005
Objectives. To assess the feasibility of ambulatory laparoscopic pyeloplasty. Laparoscopic pyeloplasty aims to reproduce the excellent functional outcomes of open pyeloplasty while diminishing procedural morbidity. Methods. Six patients fulfilled specific inclusion criteria for outpatient laparoscopic pyeloplasty: informed consent, body mass index of 40 kg/m 2 or less, primary ureteropelvic junction obstruction, uncomplicated laparoscopic surgery completed by 12:00 PM, and postoperative pain control by oral analgesics. All patients had a double-J ureteral stent placed cystoscopically before laparoscopic access. No drains were placed postoperatively. Results. All 6 patients successfully underwent laparoscopic dismembered pyeloplasty (3 left, 3 right) using the retroperitoneal (n ϭ 5) or transperitoneal (n ϭ 1) approach. The average patient age was 22 years. The mean surgical time was 223 minutes (range 165 to 270), the mean blood loss was 82 mL (range 10 to 250), and the mean postoperative hospital stay was 359 minutes (range 226 to 424). Postoperative analgesia comprised a mean of 6 mg morphine sulfate and 32 mg of ketorolac. No complications or readmissions occurred postoperatively. Intravenous urography and Lasix technetium-99m mercaptoacetyltriglycine renal scans documented resolution of obstruction. With long-term follow-up (mean 38.4 months), no recurrences have developed. Conclusions. We report our initial series of ambulatory laparoscopic pyeloplasty. In this well-selected patient population, outpatient pyeloplasty was feasible and safe. UROLOGY 66: 41-44, 2005.
Laparoscopic pyeloplasty: the updated McMaster University experience
Canadian Urological Association journal = Journal de l'Association des urologues du Canada, 2008
The open Anderson-Hynes procedure has an overall success rate of 90% for ureteropelvic junction obstruction. Laparoscopic pyeloplasty (LP) was developed to reduce morbidity and hospital stay while preserving the excellent results. We report on the results of our experience with laparoscopic pyeloplasty. Between January 2001 and May 2006, 77 consecutive patients underwent LP performed by one of 4 surgeons at our institution. Patients were reassessed with ultrasound (U/S) or intravenous pyelogram (IVP) at 6 weeks. Diuretic renal scan and U/S or IVP were performed at 6 months, and subsequent follow-up included a U/S or IVP as well as clinical assessment. Patients were assessed for pain and hydronephrosis on radiologic imaging, clearance on diuretic renal scan (T(1/2)) and differential renal function. We evaluated 73 patients. The mean patient age was 38 years (range 16-71 yr), the mean operating time was 218 minutes (range 110-409 min), and the mean blood loss was 57 mL (range 25-250 m...
Cost-effective laparoscopic pyeloplasty: Single center experience
International Journal of Urology, 2003
Objective : Laparoscopic pyeloplasty (LPP) is a minimally invasive treatment option for ureteropelvic junction (UPJ) obstruction. We report here our experience of performing cost-effective LPP on 24 patients at a single center. Methods : Between October 1999 and March 2002, LPP was performed in 24 patients (17 male, seven female; age range 8-51 years) including two patients who had failed previous endourologic treatments. In two patients with concomitant renal stones, laparoscopic pyelolithotomy was also performed. LPP was conducted in a cost-reductive manner by both transperitoneal ( n = 12) and retroperitoneal ( n = 12) access. To reduce the cost, an indigenous balloon to create the retroperitoneal space, reusable ports, ordinary polyglactin suture and intracorporeal free-hand suturing were employed. To reduce operative time, antegrade stenting was also performed in some cases. Results : Laparoscopic Anderson-Hynes pyeloplasty was performed in 16, Foley Y-V pyeloplasty in five and Fenger pyeloplasty in three patients. One patient required conversion to open surgery due to tension at the anastomosis site during Anderson-Hynes pyeloplasty. The mean operating time, blood loss, analgesic (pethidine) requirement, duration of drain and hospital stay for the retroperitoneal and transperitoneal groups were 170.3 and 187.6 min, 102.2 and 145.9 mL, 125 and 136.4 mg, 2.1 and 2.5 days, and 3.4 and 4.3 days, respectively. No significant complications were encountered apart from prolonged ileus in three patients in the transperitoneal group. The mean follow-up period was 10.8 months with a range of 2-24 months. Postoperative renal scan was performed at 3 months in 21 patients, and 1 year in 11 patients. There was evidence of equivocal obstruction in one patient, but there were no obstructions in the remaining patients. Conclusion : Although LPP is technically demanding, it is emerging as a viable, minimally invasive alternative to open pyeloplasty for UPJ obstruction with a success rate similar to that of open pyeloplasty. It allows the duplication of open surgery steps (unlike endoscopic procedures), thereby providing durable and sustained results. LPP can also be performed safely, effectively and efficiently in a cost-efficient manner.
Laparoscopic pyeloplasty: an analysis of first 100 cases and important lessons learned
International Urology and Nephrology, 2010
Aim Laparoscopic pyeloplasty (LP) is a minimally invasive approach that is becoming a standard treatment of ureteropelvic junction obstruction (UPJO). It is providing similar results when compared with open surgery. We here present our technique and analyses of experience of our first 100 cases. Patients and methods We retrospectively reviewed and analyzed the records of first 100 cases of LP performed for UPJO with dilatation of renal pelvis at our centre. Patients' profile; perioperative, intraoperative and postoperative parameters like time of surgery, blood loss, complications, duration of hospital stay, outcome of procedure were analyzed. Results The mean operative time, need for an extra-port, conversions to open, estimated blood loss, complications and recurrences all significantly decreased after first 50 cases. One patient developed shock due to bleeding from inferior epigastric vessels near port-site, and had to be explored. Overall success rate was 96%. Lesser incidence of fourth-port insertion, conversions to open, and thus decreased operative time was attributed to introduction of additional techniques to reduce the learning curve. Conclusion LP is a technically difficult procedure. Sticking to the basic steps of LP, and trying and thus incorporating additional tactics are useful to reduce the learning curve.
Journal of Laparoendoscopic & Advanced Surgical Techniques, 2011
The aim of the present study was to analyze long-term follow up (18-108 months) of different techniques and routes for laparoscopic repair of uretero-pelvic junction obstruction comparing efficacy and results. Materials and Methods: A retrospective analyses of 133 laparoscopic pyeloplasties in 132 patients (mean age 35 years) between August 1995 and November 2008 was performed. Transperitoneal route was performed in 114 patients, and retroperitoneal route was performed in 19 patients. Different repair techniques (dismembered and non-dismembered) were applied at the surgeon's discretion. Results: Average operative time was 127 minutes (range 45-370). Average blood loss was 127 mL, and mean hospital stay was 24 hours. Complications occurred in 9.6% of surgeries, and conversion rate was 1.7%. Urinary leak occurred after eight (6.1%) surgeries, all managed conservatively. Overall success rate of laparoscopic repair was 96%, higher for dismembered versus non-dismembered procedures (97% versus 89%, P = .04). Conclusion: Laparoscopic pyeloplasty is a reproducible, highly effective, and minimally invasive treatment for uretero-pelvic junction obstruction. Surgical technique affects operative time and long-term success rates. Dismembered techniques seem to remain more effective after a long-term follow up. Surgical route does not seem to affect success rates.