Retroperitoneoscopic pyeloplasty: Using reconstructive methods based on intraoperative findings

Abstract

Aim: Reconstructive laparoscopic procedures have been recognized as a less invasive treatment than conventional open procedures. However, although the laparoscopic pyeloplasty has also been accepted as useful, few findings have been reported relevant to the retroperitoneal approach. To elucidate its effectiveness and safety, laparoscopic surgery via the retroperitoneal approach was examined in our institution. Furthermore, the importance of laparoscopic observation for ureteropelvic junction and urine passage ureteropelvic junction without indwelling ureteral stent. Methods: Between July 1998 and December 2004, 13 men and 15 women underwent laparoscopic retroperitoneal surgery for ureteropelvic junction obstruction. The mean patient age was 33.6 years (range: 13-70 years). Methods of repair were determined by intraoperative findings for the relationship between the ureteropelvic junction and surrounding vessels. An indwelling ureteral stent was removed before initiating laparoscopic operation to observe the relationship between ureteropelvic junction and aberrant vessels more precisely. Results: An aberrant renal vessel was found in 13 patients (46%). Dismembered pyeloplasty was carried out in 21 patients, Y-V plasty in five patients and Hellstrom technique in two patients. Ureteral transposition was not required in dismembered pyeloplasty cases. All patients achieved retroperitoneoscopic pyeloplasty without open conversion. The mean operative time was 272 min (range: 155-490 min). The mean estimated blood loss was 44 mL (range: 10-200 mL). No major complications were observed during the intraoperative period, but urinary tract infection occurred in two patients in the postoperative period. In all patients except one, obstruction was improved or resolved. Conclusions: Laparoscopic retroperitoneal surgery is not only able to repair ureteropelvic junction obstruction, but can also be done safety and less invasively. We believe that laparoscopic observation without indwelling stent will contribute to a more appropriate choice of pyeloplasty.

Laparoscopic pyeloplasty in pediatric patients: The SGPGI experience

“…[17–25] We used transperitoneal access in all patients. Placement of stent in LP; ante grade verses retrograde, still remains a matter of debate.…”

Laparoscopic pyeloplasty in children: Long‐term outcome

“…Most authors have used transperitoneal access, although a retroperitoneal approach has also been reported 15,17–19 . Both approaches have their advantages and disadvantages 14–17 .…”

Laparoscopic and Laparoscopic Assisted Pyeloplasty for Repair of Pelvi-Ureteric Junction Obstruction in Children

“…(22) The transperitoneal approach which we utilized in all our patients is commonly used, although retroperitoneal approach has also been described. (21,23,24) In the left side pyeloplasty we utilize the Trans-mesocolic approach which proved to be safe and time saving with minimal risk of bowel injury by avoiding the mobilization of the left side colon. (25,26) We insert the JJ stent by the antegrade technique successfully in 74 renal units, same technique was described previously.…”