Laparoscopic Dismembered Pyeloplasty

Schuessler, William W.; Grune, Martin T.; Tecuanhuey, L; Preminger, Glenn M.

doi:10.1016/s0022-5347(17)35898-6

Cited by 628 publications

(308 citation statements)

References 26 publications

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“…The results of LP are shown in Table 1 [4][5][6][7][8][9][10]; several early reports were excluded where updated results from the same institution were published more recently. Several points are worth specific comment.…”

Section: Resultsmentioning

confidence: 99%

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Laparoscopic pyeloplasty: the first decade

2004

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ports introduced to enable dissection and identification of the PUJ. The technical principles and goals are similar to those of open surgery. Depending on the type of procedure the PUJ is either incised or dismembered, and reductive pyeloplasty performed if indicated. The ureteric JJ stent is typically inserted retrogradely before (the authors' preference being 4.7 F, 26 cm) or during surgery. A drain is inserted to lie adjacent to the completed repair and a Foley catheter is left in the bladder.Patients typically commence free oral intake of fluids 8-12 h after surgery; the urethral catheter is removed after 1-2 days and the wound drain subsequently. The ureteric stent is typically removed by outpatient flexible cystoscopy at 4 weeks, after IVU. RESULTSThe results of LP are shown in Table 1 [4][5][6][7][8][9][10]; several early reports were excluded where updated results from the same institution were published more recently. Several points are worth specific comment. The success rates of LP are consistently high, at 87-98%; the rates are > 95% in series with a predominance of primary procedures, with only one exception. The 'success rate' is defined as the objective radiological success, i.e. with a patent and unobstructed PUJ (or an improvement in drainage) by either IVU or diuretic renography. Subjective improvement rates, e.g. from patient questionnaires, are invariably less than the radiological success rates by 10-30% for both open and endourological pyeloplasty. There are several possible reasons for this discrepancy, but the present discussion focuses on the objective radiological success rate, which is reported rather more consistently. The prolonged operative duration of reconstructive laparoscopy is significant, but there has been a trend towards a reduction, from a mean of 330 min in the original series to 164-252 min in contemporary series reported in the last 3 years [6][7][8][9]11]. This reflects increased confidence and ability in intracorporeal suturing and knot-tying. Laparoscopic suturing and knot-tying can be learned effectively and reinforced by regular repetition in a 'dry lab' environment. The effect of increasing experience is notable, with an experienced laparoscopist consistently performing the entire procedure (transperitoneal) in < 3.5 h [9]. The retroperitoneal approach (mean operative duration 175 min) is seemingly quicker than the transperitoneal approach (mean 246 min) in contemporary series reported since 2001. This is probably because it takes less time to dissect and identify the PUJ with the retroperitoneal technique. The low morbidity of LP is well reflected in the low incidence of complications during and after surgery even in the initial series. The risks of blood transfusion are remarkably low, being limited to anecdotal reports, in sharp contradistinction to endopyelotomy, where the transfusion rates are 3-11%. The hospital stay is short, averaging 3.8 days in the series reported since 2000.To our knowledge there has been at least one abortive attempt to compare laparosc...

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Section: Resultsmentioning

confidence: 99%

“…Laparoscopic pyeloplasty (LP) was introduced in 1993 by Schuessler et al [4] and has developed worldwide as the first minimally invasive option to match the success rates of open pyeloplasty, while achieving the added goals of low morbidity, short hospital stay and convalescence. Herein, we review the current status of LP.…”

Section: Introductionmentioning

confidence: 99%

Laparoscopic pyeloplasty: the first decade

2004

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“…Laparoscopic pyeloplasty, first performed by Schuessler et al (5), in 1993, maintains the principles of open dismembered pyeloplasty, with excellent functional results and significant reductions in morbidity (6).…”

Section: Introductionmentioning

confidence: 99%

Transperitoneal laparoscopic pyeloplasty: Brazilian initial experience with 55 cases

et al. 2010

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Purpose: To evaluate prospectively the results obtained in 55 patients undergoing laparoscopic pyeloplasty through transperitoneal access. Materials and Methods: From January 2005 to July 2009, fifty-five patients between 13 and 64 years old, were treated for ureteropelvic junction (UPJ) stenosis via a transperitoneal laparoscopy. All patients had clinical symptoms of high urinary obstruction and hydronephrosis confirmed by imaging methods. Anderson-Hynes dismembered pyeloplasty was performed in 51 patients and Fenger technique in the other 4 cases. Patients were clinically and imaging evaluated in the postoperative period at 3 and 6 months and then followed-up annually. Results: The operative time ranged from 95 to 270 min. The mean hospital stay was 2 days. The average blood loss was 170 mL. The time to return to normal activities ranged from 10 to 28 days. Anomalous vessels were identified in 27 patients, intrinsic stenosis in 23 patients and 5 patients had high implantation of the ureter. Laparoscopic pyelolithotomy was successfully performed in 6 patients with associated renal stones. That series monitoring ranged from 1 to 55 months. One patient had longer urinary fistula (11 days), 3 patients had portal infection and 6 patients had prolonged ileus. There was one conversion due to technical difficulties. From the later postoperative complications, 2 patients had re-stenosis, one determined by Anderson-Hynes technique and the other by Fenger technique. The success rate was 95.65%. Conclusions: Laparoscopic pyeloplasty has functional results comparable to conventional open technique. It offers less morbidity, with aesthetic and post-operative convalescence benefits and lower complication rates.

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“…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.…”

Section: Laparoscopic Pyeloplastymentioning

confidence: 88%

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

Eden

1997

British Journal of Urology

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Laparoscopic Dismembered Pyeloplasty

Cited by 628 publications

References 26 publications

Laparoscopic pyeloplasty: the first decade

Laparoscopic pyeloplasty: the first decade

Transperitoneal laparoscopic pyeloplasty: Brazilian initial experience with 55 cases

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

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