Laparoscopic Pyeloplasty: Our New Gold Standard

Symons, Stephanie; Bhirud, Parag S; Jain, Vikas; Shetty, Ajay S.; Desai, Mahesh

doi:10.1089/end.2008.0208

Cited by 49 publications

(25 citation statements)

References 13 publications

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“…12,13 Nevertheless, the transperitoneal approach is used for most pyeloplastic surgery for UPJ obstruction and for some retroperitoneal tumor resections. [14][15][16] This is most likely because the wide working space and the presence of hydronephrosis helps surgeons to recognize the renal pelvis easily and reduce excessive lysis to expose the urinary tract. Without hydronephrosis, wide manipulation of the colon, duodenum, spleen, pancreas, and kidney must be done to fi nd the urinary tract.…”

Section: Discussionmentioning

confidence: 99%

Retroperitoneoscopic treatment of ureteral invagination caused by a long fibroepithelial polyp protruding into the bladder: Report of a case

et al. 2011

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Section: Discussionmentioning

confidence: 99%

Retroperitoneoscopic treatment of ureteral invagination caused by a long fibroepithelial polyp protruding into the bladder: Report of a case

et al. 2011

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“…Although excellent outcomes have been reported for laparoscopic pyeloplasty from centres with considerable laparoscopic expertise [2,11], widespread uptake of this procedure has not been uniform due to the surgical challenges associated with intra-corporeal reconstruction. Technical advantages offered by the da Vinci Ò surgical system such as improved visualisation and wristed instruments will undoubtedly reduce some of these challenges.…”

Section: Discussionmentioning

confidence: 99%

Robotic-assisted laparoscopic pyeloplasty: initial Australasian experience

et al. 2009

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Laparoscopic dismembered pyeloplasty has a success rate in excess of 90% for the treatment of uretero-pelvic junction (UPJ) obstruction. Laparoscopic intracorporeal suturing, however, remains technically challenging and may lead to prolonged operating times. Robotic-assisted suturing using the da Vinci(®) surgical system (Intuitive Surgical, CA, USA) may reduce the difficulty associated with intra-corporeal suturing. The da Vinci(®) surgical system was used to facilitate intra-corporeal suturing in adults undergoing trans-peritoneal robotic-assisted laparoscopic pyeloplasty (RALPY) at our institution. Initially, the robot was only docked for the anastomosis, but in the later part of the series the robot was used for all parts of the dissection and reconstruction. Peri-operative and outcome data were recorded prospectively. Twenty-four patients underwent RALPY over a 4-year period. The mean age was 46.6 (range 18-76) years. The mean total operative time was 211 min (range 150-317 min) with an anastomotic time of 44 min (range 30-55 min). The mean estimated blood loss was 56 ml (10-150 ml) and there was one temporary urine leak managed by 24 h of urethral catheterization. The median length of stay was 4 (2-10) days. Patients underwent diuretic renography at 6 months post surgery, and satisfactory renal drainage was demonstrated in all cases. RALPY is a feasible and safe option for the management of UPJ obstruction. This technology may reduce the difficulty associated with complex laparoscopic suturing and facilitate shorter operative times with excellent outcomes. This is now our preferred approach for all patients opting for surgical management of UPJ obstruction.

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“…The success rates of LP have been reported consistently above 90% and comparable to OP, while achieving minimal morbidity by obviating the need for a substantial incision [5,7,17,[23][24][25]. Although the steep learning curve meant that operating time was prolonged, this has shown a downward trend with increasing familiarity of laparoscopic techniques and better laparoscopic equipment.…”

Section: Laparoscopic Pyeloplastymentioning

confidence: 99%

“…A minimal invasive procedure, LP was able to achieve the same consistent high success rates of OP, yet shorten the length of hospital stay and achieve rapid recovery. LP has even replaced OP as the gold standard of care in various urological centers [7,8]. However, the steep learning curve of LP due to the technical challenges of intracorporeal suturing has limited its application.…”

Section: Introductionmentioning

confidence: 99%

Endopyelotomy in the Age of Laparoscopic and Robotic-Assisted Pyeloplasty

Yong

Albala

2010

Curr Urol Rep

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Ureteropelvic junction obstructixon (UPJO) management has undergone significant changes in the past few years. The aim of this review is to establish the role of endopyelotomy in the age of laparoscopic and robot-assisted laparoscopic pyeloplasty (RALP). Open pyeloplasty (OP) has been the gold standard of care for UPJO for the past six decades. Due to lower long-term efficacy, endopyelotomy has failed to replace OP. However, laparoscopic pyeloplasty (LP) has been able to reproduce the high success rates of OP, while also achieving minimal morbidity. Unfortunately, the steep learning curve and technical difficulties have hindered its use. Recently, robot-assisted systems have enabled LP to overcome its disadvantages, and this may render endopyelotomy obsolete. Although LP and RALP are emerging as the gold standard of treatment for UPJO, endopyelotomy could carve out a niche area as a salvage procedure. Endopyelotomy will continue to have a role in the management of UPJO, albeit a smaller one.

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Laparoscopic Pyeloplasty: Our New Gold Standard

Cited by 49 publications

References 13 publications

Retroperitoneoscopic treatment of ureteral invagination caused by a long fibroepithelial polyp protruding into the bladder: Report of a case

Retroperitoneoscopic treatment of ureteral invagination caused by a long fibroepithelial polyp protruding into the bladder: Report of a case

Robotic-assisted laparoscopic pyeloplasty: initial Australasian experience

Endopyelotomy in the Age of Laparoscopic and Robotic-Assisted Pyeloplasty

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