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Transperitoneal laparoscopic pyeloplasty in the treatment of ureteropelvic junction obstruction.

Rivas JG, Gregorio SA, Eastmond MA, Gómez AT, Ledo JC, Togores LH, Barthel JJ - Cent European J Urol (2013)

Bottom Line: In the last 2 years we used 3 mm and 5 mm ports in order to achieve better cosmetics results.In the case of bilateral statistical tests were considered significant as those with p values <0.05.Mean follow-up was 45 months and a success was achieved in 91%.

View Article: PubMed Central - PubMed

Affiliation: Department of Urology, Hospital Universitario La Paz, Madrid, Spain.

ABSTRACT

Introduction: Laparoscopic pyeloplasty was first described by Schuessler. During the last decade, this technique has been developed in order to achieve the same results as open surgery, with lower rates of morbidity and complications. In this study we review our experience using laparoscopic pyeloplasty as the gold standard for the treatment of the ureteropelvic junction obstruction (UPJO).

Material and methods: We performed a retrospective review of 62 laparoscopic pyeloplasties carried out at our center. In the last 2 years we used 3 mm and 5 mm ports in order to achieve better cosmetics results. Demographic data is described and the functionality of the affected kidney and surgical data, among others were analyzed statistically. In the case of bilateral statistical tests were considered significant as those with p values <0.05.

Results: The most frequent reason for consultation was ureteral pain. Patients mean age was 40 years and 94% of them had preoperative renogram showing a full or partial obstructive pattern. The right side was affected in 61% of cases and the left in the remaining 39%. The presence of stones was observed in 12 patients and crossing vessels in 58% of cases. The average stay was 3.72 days. Post-surgery complications were observed in two patients. The operative time was 178 minutes. Mean follow-up was 45 months and a success was achieved in 91%.

Conclusions: The transperitoneal laparoscopic pyeloplasty has become the gold standard for the treatment of ureteropelvic junction stenosis in our center because of high success rate, shorter postoperative stay, and low intra and postoperative complications.

No MeSH data available.


Related in: MedlinePlus

Left: Vision of the UPU through transperitoneal laparoscopic approach. Right: Catheterization using nephroscopy needle.
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Figure 0001: Left: Vision of the UPU through transperitoneal laparoscopic approach. Right: Catheterization using nephroscopy needle.

Mentions: Technical description (Figure 1): In our center, after general anesthesia, the patient is placed at 45 degrees with the lateral opening centered on the operating table. After making pneumoperitoneum, we perform a transperitoneal approach with four ports. To obtain better cosmetic results, in the last two years we have evolved the port placement technique to a 5 mm trocar for the 30° view telescopic lens, a transumbilical trocar, and three work trocars of 3 mm. The colon is dissected along the avascular Toldt line and rejected medially to expose the homolateral ureteropelvic junction (UPJ). The mobilization of the UPJ should be done with great care, identifying the possible existence of polar vessels. Once the opening and resection of UPJ is performed, in most cases we perform percutaneous ureteral catheterization with needle–nephroscopy trocar according to the technique described by Alonso et al. [10] (Figure 1). From our point of view it is the safest and the fastest way of antegrade catheterization. The anastomosis is performed with 4/0Vicryl suture. At the end of surgery approaching the peritoneum and Gerota's fascia is done and usually a drain is left in the surgical bed and is removed 24–48 hrs later. Bladder catheter is left during the hospital stay; it is removed 24–48 hrs after surgery. Staples are placed in the skin wounds. The ureteral catheter is removed in 4–6 weeks.


Transperitoneal laparoscopic pyeloplasty in the treatment of ureteropelvic junction obstruction.

Rivas JG, Gregorio SA, Eastmond MA, Gómez AT, Ledo JC, Togores LH, Barthel JJ - Cent European J Urol (2013)

Left: Vision of the UPU through transperitoneal laparoscopic approach. Right: Catheterization using nephroscopy needle.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3974479&req=5

Figure 0001: Left: Vision of the UPU through transperitoneal laparoscopic approach. Right: Catheterization using nephroscopy needle.
Mentions: Technical description (Figure 1): In our center, after general anesthesia, the patient is placed at 45 degrees with the lateral opening centered on the operating table. After making pneumoperitoneum, we perform a transperitoneal approach with four ports. To obtain better cosmetic results, in the last two years we have evolved the port placement technique to a 5 mm trocar for the 30° view telescopic lens, a transumbilical trocar, and three work trocars of 3 mm. The colon is dissected along the avascular Toldt line and rejected medially to expose the homolateral ureteropelvic junction (UPJ). The mobilization of the UPJ should be done with great care, identifying the possible existence of polar vessels. Once the opening and resection of UPJ is performed, in most cases we perform percutaneous ureteral catheterization with needle–nephroscopy trocar according to the technique described by Alonso et al. [10] (Figure 1). From our point of view it is the safest and the fastest way of antegrade catheterization. The anastomosis is performed with 4/0Vicryl suture. At the end of surgery approaching the peritoneum and Gerota's fascia is done and usually a drain is left in the surgical bed and is removed 24–48 hrs later. Bladder catheter is left during the hospital stay; it is removed 24–48 hrs after surgery. Staples are placed in the skin wounds. The ureteral catheter is removed in 4–6 weeks.

Bottom Line: In the last 2 years we used 3 mm and 5 mm ports in order to achieve better cosmetics results.In the case of bilateral statistical tests were considered significant as those with p values <0.05.Mean follow-up was 45 months and a success was achieved in 91%.

View Article: PubMed Central - PubMed

Affiliation: Department of Urology, Hospital Universitario La Paz, Madrid, Spain.

ABSTRACT

Introduction: Laparoscopic pyeloplasty was first described by Schuessler. During the last decade, this technique has been developed in order to achieve the same results as open surgery, with lower rates of morbidity and complications. In this study we review our experience using laparoscopic pyeloplasty as the gold standard for the treatment of the ureteropelvic junction obstruction (UPJO).

Material and methods: We performed a retrospective review of 62 laparoscopic pyeloplasties carried out at our center. In the last 2 years we used 3 mm and 5 mm ports in order to achieve better cosmetics results. Demographic data is described and the functionality of the affected kidney and surgical data, among others were analyzed statistically. In the case of bilateral statistical tests were considered significant as those with p values <0.05.

Results: The most frequent reason for consultation was ureteral pain. Patients mean age was 40 years and 94% of them had preoperative renogram showing a full or partial obstructive pattern. The right side was affected in 61% of cases and the left in the remaining 39%. The presence of stones was observed in 12 patients and crossing vessels in 58% of cases. The average stay was 3.72 days. Post-surgery complications were observed in two patients. The operative time was 178 minutes. Mean follow-up was 45 months and a success was achieved in 91%.

Conclusions: The transperitoneal laparoscopic pyeloplasty has become the gold standard for the treatment of ureteropelvic junction stenosis in our center because of high success rate, shorter postoperative stay, and low intra and postoperative complications.

No MeSH data available.


Related in: MedlinePlus