Extraperitoneal laparoscopic dismembered fibrin‐glued pyeloplasty: medium‐term results

Abstract

Objective To assess the feasibility and results of perhospitalization was 2 (2-4) nights. A shortened fibrotic ureter prevented the laparoscopic completion forming retroperitoneoscopic dismembered fibringlued pyeloplasty in a clinical series of patients with of the second case, which was converted to an open procedure. Follow-up imaging after 1-2 years showed pelvi-ureteric junction (PUJ) obstruction. Patients and methods A balloon-dissecting four-port satisfactory upper tract drainage in those cases completed successfully. One patient developed a renal extraperitoneal laparoscopic approach was used in each of nine patients (aged 21-60 years) to dismember pelvic calculus that was treated by extracorporeal shock wave lithotripsy. the PUJ over a previously placed double-pigtail stent, insert stay sutures to appose the urothelium and Conclusion This technique is associated with a significantly shorter operating time than historical complete the pelvi-ureteric anastomosis using fibrin glue. Anastomoses were assessed by diuresis renogralaparoscopic controls, and with a significantly lower post-operative opiate analgesic requirement and phy 3 months after surgery and at yearly intervals thereafter.shorter post-operative hospitalization than in a contemporaneous series of patients undergoing open Results Eight of the nine attempted procedures were completed successfully in a median (range) operating pyeloplasty. However, longer term follow-up is needed to fully assess the performance of these anastomoses.

Treatment options for pelvi‐ureteric junction obstruction: implications for practice and training

“…The mean operating time of 185 min in the present author's series [68] of Technique extraperitoneal laparoscopic dismembered pyeloplasty was significantly shorter than that for historical controls A variety of techniques has been used, including those traditionally used in open pyeloplasty, for which long-(P<0.001, two-sample t-test). This was due partly to the adoption of the more direct laparoscopic approach term follow-up results are available, and those which are not [61].…”

“…The mean success rate of the eight series reporting Results the results of 31 laparoscopic pyeloplasties (24 of which were dismembered) is comparable to that of open disThe most striking feature of the series of laparoscopic dismembered pyeloplasty (Table 2) [61][62][63][64][65][66][67] are the membered pyeloplasty, at 97.1% [61][62][63][64][65][66][67][68]. However, the follow-up for these patients is currently too short (mean extremely long operating times (mean 306 min), much 7.9 months) to allow any definitive statement about the Implications for current practice and training eÃcacy of this approach.…”

“…Both intellectually and practically it will always be more appealing to achieve the same surgical result by a Complications method which creates the least trauma of access, as this leads to better post-operative patient comfort and an The complications of pulmonary embolus in two patients [61,67] and stone formation in one patient [62] encounearlier discharge from hospital, as well as a more rapid convalescence and return to work. However, when it tered in these series have been reported after open pyeloplasty [68,69]. Clearly, details of further cases are comes to choosing the 'best' minimal-access technique for the treatment of PUJ obstruction, there are two needed before the relationship between this approach and its associated pulmonary embolism rate (worryingly, confounding factors.…”

Current applications of fibrin sealant in urologic surgery

“…Fibrin sealant has been shown to successfully support approximating sutures in a porcine model of laparoscopic ureteral anastomoses (31) and has improved radiographic outcomes compared to free needle suturing and laser weld closure (32). A variety of studies have shown fibrin sealant to be effective as a bolster for laparoscopic pyeloplasty or collecting system repair (33), and satisfactory drainage has been confirmed by radiologic imaging at one to two years (34).…”

Laparoscopic Ureterocalicostomy: Development of a Technique Simplified by Application of Nitinol Clips and a Wet Monopolar Electrosurgery Device

“…10 Its use as an anastomotic sealant during laparoscopic reconstruction of the urinary tract has also been suggested. 11 Herein, we describe the technique we developed for simplified laparoscopic ureterocalicostomy in the porcine model. We compared the use of absorbable sutures for anastomotic reconstruction with the use of Nitinol clips.…”