With increasing experience in laparoscopic reconstructive urologic procedures, laparoscopic pyeloureterostomy is a feasible option, even in infants.

Background:Laparoscopic pyeloplasty is one of the most common reconstructive procedures performed by urologists. Both continuous and interrupted sutures are being practiced for ureteropelvic anastomosis. The success rate and the complications associated with the suturing technique needs evaluation. We analyzed the results from of our patients who underwent laparoscopic pyeloplasty using both techniques.Objective:To review the outcome differences among patients undergoing laparoscopic pyeloplasty regarding suturing technique.Materials and Methods:All patients who underwent laparoscopic, transperitoneal dismembered pyeloplasty of the primary pelviureteric obstruction were analyzed. The primary outcome was successful pyeloplasty, as assessed by the resolution of symptoms and T½ <10 minutes. The secondary outcomes were the complication rate and the operative parameters. The difference in the parameters was assessed by Student t test analysis.Results:Of the 107 patients we studied, 65 had interrupted suturing and 42 had continuous suturing. The success rate was not significantly different among the 2 groups. The mean suturing time, postoperative drainage volume, postoperative hospital stay, and total cost of the procedure were significantly less in the continuous suturing group.Conclusion:The continuous suturing technique is preferred over the interrupted suturing technique for laparoscopic pyeloplasty because the success rates are equal and the postoperative stay, suturing time, drain output, and cost of the procedure are better.

We report the technique of laparoscopic repair of vesicouterine fistula. A 30 year old lady presented with incapacitating cyclical pain for one and a half years. She had undergone cesarean section 18 months ago. She was evaluated by a CT scan of abdomen and pelvis followed by a cystoscopy and diagnosed to have a vesicouterine fistula. This was managed laparoscopically (laparoscopic disconnection of fistula; closure of bladder and uterine rent; and omental interposition). There were no intraoperative or postoperative complications. Follow up CT scan of abdomen and cystoscopy revealed good healing of the repaired area. Laparoscopic repair of vesicouterine fistula is a feasible procedure.

Laparoscopic Boari flap reimplantation is a challenging procedure. With increasing technical skill and confidence, one can attempt the procedure with the obvious advantage to the patient.

Port site hernia is an uncommon complication in children undergoing laparoscopy. The drain site is the predominant location of port site hernia. Sedation during drain removal and judicious use of drain may help to decrease such occurrences.

Symptomatic benign prostatic hyperplasia (BPH) is managed medically worldwide, but transurethral resection of prostate (TURP) is the gold standard in refractory cases. Holmium laser enucleation of prostate (HoLEP), laser vaporization are other options which are widely practiced. However in larger glands which are more than 80 g, open adenomectomy is still practiced. Laparoscopic adenomectomy is a minimally invasive option in such circumstances. This article explains about different techniques in minimally invasive adenomectomy and the role for this procedure today. Laparoscopic simple prostatectomy (LSP) has a place in symptomatic, larger prostatic adenoma in the hands of experienced laparoscopic surgeons when open simple prostatectomy is needed.

Laparoendoscopic single site surgery (LESS) is a new avenue in laparoscopic urology. The main advantage is the enhanced cosmetic benefits of single hidden scar. Lately many papers are being published on various procedures done by LESS. Like conventional laparoscopy, this approach is likely to be used more widely and hence exposure to this field is essential. However, formal training in this technique is not widely available. Expensive ports and nonavailability of endotrainer may be the factors deterring the training. We have modified the standard laparoscopic endotrainer with improvised ports, to make it suitable for single port laparoscopic training. For the animal lab training improvised ports and low cost instruments were used. Thus the overall cost of the training in LESS was reduced, and better confidence levels were achieved prior to human applications.

The usage of a 3D camera and experience of the surgeon reduced the time difference between continuous and interrupted suturing in laparoscopic pyeloplasty. The outcome between interrupted and continuous suturing groups were the same. Though the drainage volume was more with interrupted suturing group the outcome was not altered.