1
|
Shimizu N, Naya Y, Sekine K, Hou K, Okato A, Suyama T, Araki K, Masuda H, Kojima S. Laparoscopic redo pyeloplasty with a buccal mucosal graft. IJU Case Rep 2023; 6:124-127. [PMID: 36874993 PMCID: PMC9978060 DOI: 10.1002/iju5.12567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 12/02/2022] [Indexed: 12/24/2022] Open
Abstract
Introduction Redo pyeloplasty can be difficult due to scar tissue or fibrosis. Ureteral reconstruction with a buccal mucosal graft is performed safely and successfully, but most reports of ureteral reconstruction using a buccal mucosal graft are of robot-assisted surgery, with few reports of laparoscopic-assisted surgery. A case of laparoscopic-assisted redo pyeloplasty using a buccal mucosal graft is presented. Case presentation A 53-year-old woman was diagnosed with ureteropelvic junction obstruction, and a double-J stent was placed to relieve backache. She visited our hospital 6 months after double-J stent placement. Three months later, laparoscopic pyeloplasty was performed. At 2 months postoperatively, anatomic stenosis occurred. Holmium laser endoureterotomy and balloon dilation were performed; however, the anatomic stenosis recurred, and laparoscopic redo pyeloplasty with a buccal mucosal graft was performed. After redo pyeloplasty, obstruction was improved, and her symptoms disappeared. Conclusion This is the first case of using a buccal mucosal graft for laparoscopic pyeloplasty in Japan.
Collapse
Affiliation(s)
- Nobuhiko Shimizu
- Department of Urology Teikyo University Chiba Medical Center Ichihara Chiba Japan
| | - Yukio Naya
- Department of Urology Teikyo University Chiba Medical Center Ichihara Chiba Japan
| | - Keita Sekine
- Department of Urology Teikyo University Chiba Medical Center Ichihara Chiba Japan
| | - Kyokushin Hou
- Department of Urology Teikyo University Chiba Medical Center Ichihara Chiba Japan
| | - Atsushi Okato
- Department of Urology Teikyo University Chiba Medical Center Ichihara Chiba Japan
| | - Takahito Suyama
- Department of Urology Teikyo University Chiba Medical Center Ichihara Chiba Japan
| | - Kazuhiro Araki
- Department of Urology Teikyo University Chiba Medical Center Ichihara Chiba Japan
| | - Hiroshi Masuda
- Department of Urology Teikyo University Chiba Medical Center Ichihara Chiba Japan
| | - Satoko Kojima
- Department of Urology Teikyo University Chiba Medical Center Ichihara Chiba Japan
| |
Collapse
|
2
|
Ritchie A, Pacilli M, Nataraja RM. Simulation-based education in urology - an update. Ther Adv Urol 2023; 15:17562872231189924. [PMID: 37577030 PMCID: PMC10413896 DOI: 10.1177/17562872231189924] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Accepted: 07/08/2023] [Indexed: 08/15/2023] Open
Abstract
Over the past 30 years surgical training, including urology training, has changed from the Halstedian apprenticeship-based model to a competency-based one. Simulation-based education (SBE) is an effective, competency-based method for acquiring both technical and non-technical surgical skills and has rapidly become an essential component of urological education. This article introduces the key learning theory underpinning surgical education and SBE, discussing the educational concepts of mastery learning, deliberate practice, feedback, fidelity and assessment. These concepts are fundamental aspects of urological education, thus requiring clinical educators to have a detailed understanding of their impact on learning to assist trainees to acquire surgical skills. The article will then address in detail the current and emerging simulation modalities used in urological education, with specific urological examples provided. These modalities are part-task trainers and 3D-printed models for open surgery, laparoscopic bench and virtual reality trainers, robotic surgery simulation, simulated patients and roleplay, scenario-based simulation, hybrid simulation, distributed simulation and digital simulation. This article will particularly focus on recent advancements in several emerging simulation modalities that are being applied in urology training such as operable 3D-printed models, robotic surgery simulation and online simulation. The implementation of simulation into training programmes and our recommendations for the future direction of urological simulation will also be discussed.
Collapse
Affiliation(s)
- Angus Ritchie
- Departments of Paediatrics and Surgery, School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - Maurizio Pacilli
- Departments of Paediatrics and Surgery, School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
- Department of Paediatric Surgery and Monash Children’s Simulation, Monash Children’s Hospital, Melbourne, Australia
| | - Ramesh M. Nataraja
- Department of Paediatric Surgery and Monash Children’s Simulation, Monash Children’s Hospital, 246 Clayton Road, Clayton, Melbourne 3168, Australia
- Departments of Paediatrics and Surgery, School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne 3168, Australia
| |
Collapse
|
3
|
Merder E, Arıman A, Sabuncu K, Altunrende F. Functional, morphological and operative outcome after pyeloplasty in adult patients: Laparoscopic versus open. Urologia 2021; 88:227-231. [PMID: 33413037 DOI: 10.1177/0391560320987921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE The aim of this study is determine and compare improvement of hydronephrosis, renal function, and operative outcome between laparoscopıc and open pyeloplasty in adults. MATERIAL AND METHODS Sixty-five adult patients with primary ureteropelvic junction obstruction (UPJO) underwent pyeloplasty between January 2014 and September 2020. Thirty-four patients had laparoscopıc pyeloplasty (LP), 31 patients had open pyeloplasty (OP). In this retrospective study demographics, differential renal function (DRF), hydronephrosis, anteroposterior diameter of pelvis renalis (APD) and operative outcomes: operation time, blood loss, complications, hospital stay, etiology, analgesic requirement, complications, and success rates were compared between two groups. RESULTS Improvement of APD is higher in OP group (p: 0.001). Improvement of DRF (p: 0.713) and hydronephrosis (p = 1.000), success (p: 0.407) and complication rate (p: 0.661) are comparable between two groups. Median hospital stay, postoperative analgesia requirement and blood loss was less in LP group, mean operative time was shorter in OP group (p: 0.001). CONCLUSION Pain complaints are greatly reduced after pyeloplasty in adult patients but the drainage of kidney, DRF and hydronephrosis does not improve as much as desired. Improvement of APD is better and median operative time is less in OP, intraoperative blood loss, hospital stay, and analgesic requirement is less in LP group in our study.
Collapse
Affiliation(s)
- Erkan Merder
- Urology, University of Health Sciences, Prof. Dr. Cemil Taşcıoğlu City Hospital, Istanbul, Turkey
| | - Ahmet Arıman
- Urology, University of Health Sciences, Prof. Dr. Cemil Taşcıoğlu City Hospital, Istanbul, Turkey
| | - Kenan Sabuncu
- Urology, University of Health Sciences, Prof. Dr. Cemil Taşcıoğlu City Hospital, Istanbul, Turkey
| | - Fatih Altunrende
- Urology, University of Health Sciences, Prof. Dr. Cemil Taşcıoğlu City Hospital, Istanbul, Turkey
| |
Collapse
|
4
|
Rehman OF, Umair M, Hussain AK, Faraz A, Iqbal M, Waqar M, Tahir M, Khan AR. Laparoscopic Versus Open Pyeloplasty for Primary Pelvic Ureteric Junction Obstruction: A Prospective Single Centre Study. Cureus 2020; 12:e11087. [PMID: 33235822 PMCID: PMC7679050 DOI: 10.7759/cureus.11087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Introduction The aim of the study was to compare the clinical and patient-reported outcomes among open pyeloplasty (OP) and laparoscopic pyeloplasty (LP) patients. Materials and methods This was a prospective single centre, case-cohort study conducted in a tertiary care hospital with 62 patients. In both techniques, dismembered Anderson-Hynes pyeloplasty were undertaken. Post-operatively patients underwent visual analogue scale (VAS) assessment for pain, days to ambulation and comparison of the short- and long-term outcomes of the two procedures. Results There was no difference in the physical and functional outcomes between the two surgical approaches at 12 months period after surgery. However, patients in the laparoscopic group did report a higher rate of satisfaction at six weeks and six months’ postoperatively. Likewise, patients in LP experienced less pain during the postoperative period (p-value <0.001), with decreased analgesic requirements. This translated into an early patient ambulation in the laparoscopic group (p-value <0.001), and a shorter hospital stay for the LP group (p-value <0.001). Moreover, follow-up ultrasound showed equal improvement of hydronephrosis among the two groups. Conclusion Laparoscopic and open pyeloplasty are equally effective in treating pelvic ureteric junction obstruction (PUJO), with comparable patient-reported outcomes at 12-month follow-up. However, the laparoscopic technique merits over open surgery with faster rehabilitation, a decreased postoperative pain experience and shorter hospital stay.
Collapse
Affiliation(s)
- Omer Farooq Rehman
- Urology, Armed Forces Institute of Urology, Rawalpindi, PAK.,Urology, Maqsood Medical Complex and General Hospital, Peshawar, PAK
| | - Musab Umair
- Urology, Armed Forces Institute of Urology, Rawalpindi, PAK.,Urology, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | | | - Ahmad Faraz
- Trauma and Orthopaedics, Leeds Teaching Hospitals NHS Trust, Leeds, GBR
| | - Mohammad Iqbal
- Orthopaedics and Trauma, Royal Shrewsbury and Telford Hospital National Health Service Trust, Shrewsbury, GBR
| | - Muhammad Waqar
- Urology, Maqsood Medical Complex and General Hospital, Peshawar, PAK
| | - Muhammad Tahir
- Orthopaedics, Jinnah Postgraduate Medical Centre, Karachi, PAK
| | | |
Collapse
|
5
|
Al-Hazmi H, Peycelon M, Carricaburu E, Manzoni G, Neel KF, Ali L, Grapin C, Paye-Jaouen A, El-Ghoneimi A. Redo Laparoscopic Pyeloplasty in Infants and Children: Feasible and Effective. Front Pediatr 2020; 8:546741. [PMID: 33240828 PMCID: PMC7683417 DOI: 10.3389/fped.2020.546741] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Accepted: 08/12/2020] [Indexed: 12/18/2022] Open
Abstract
Purpose: To determine the feasibility and effectiveness of redo laparoscopic pyeloplasty among patients with failed previous pyeloplasty, specifically examining rates of success and complications. Materials and Methods: We retrospectively reviewed the charts of all patients, who underwent redo laparoscopic pyeloplasty from 2006 to 2017. This included patients who underwent primary pyeloplasty at our institution and those referred for failures. Analysis included demographics, operative time, complications, length of hospital stay, complications, and success. Success was defined as improvement of symptoms and hydronephrosis and/or improvement in drainage demonstrated by diuretic renogram, especially in those with persistent hydronephrosis. Descriptive statistics are presented. Results: We identified 22 patients who underwent redo laparoscopic pyeloplasty. All had Anderson-Hynes technique except two cases in which ureterocalicostomy was performed. Median (IQR) follow-up was 29 (2-120) months, median time between primary pyeloplasty and redo laparoscopic pyeloplasty was 12 (7-49) months. The median operative time was 200 (50-250) min, and median length of hospital stay was 3 (2-10) days. The procedure was feasible in all cases without conversion. During follow-up, all but two patients demonstrated an improvement in the symptoms and the degree of hydronephrosis. Ninety-one percent of patients experienced success and no major complications were noted. Conclusions: Redo laparoscopic pyeloplasty is feasible and effective with a high success rate and low complication rate.
Collapse
Affiliation(s)
- Hamdan Al-Hazmi
- Department of Pediatric Urology, Robert-Debré University Hospital, Assistance Publique - Hôpitaux de Paris (APHP), Paris, France.,College of Medicine and King Saud University Medical City, King Saud University, Riyad, Saudi Arabia
| | - Matthieu Peycelon
- Department of Pediatric Urology, Robert-Debré University Hospital, Assistance Publique - Hôpitaux de Paris (APHP), Paris, France.,National Reference Center of Rare Urinary Tract Malformations (MARVU), Paris, France.,University of Paris, Paris, France
| | - Elisabeth Carricaburu
- Department of Pediatric Urology, Robert-Debré University Hospital, Assistance Publique - Hôpitaux de Paris (APHP), Paris, France.,National Reference Center of Rare Urinary Tract Malformations (MARVU), Paris, France
| | - Gianantonio Manzoni
- Department of Pediatric Urology, Robert-Debré University Hospital, Assistance Publique - Hôpitaux de Paris (APHP), Paris, France.,Department of Pediatric Urology Fondazione Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Khalid Fouda Neel
- Department of Pediatric Urology, Robert-Debré University Hospital, Assistance Publique - Hôpitaux de Paris (APHP), Paris, France.,College of Medicine and King Saud University Medical City, King Saud University, Riyad, Saudi Arabia
| | - Liza Ali
- Department of Pediatric Urology, Robert-Debré University Hospital, Assistance Publique - Hôpitaux de Paris (APHP), Paris, France.,National Reference Center of Rare Urinary Tract Malformations (MARVU), Paris, France
| | - Christine Grapin
- Department of Pediatric Urology, Robert-Debré University Hospital, Assistance Publique - Hôpitaux de Paris (APHP), Paris, France.,National Reference Center of Rare Urinary Tract Malformations (MARVU), Paris, France.,University of Paris, Paris, France
| | - Annabel Paye-Jaouen
- Department of Pediatric Urology, Robert-Debré University Hospital, Assistance Publique - Hôpitaux de Paris (APHP), Paris, France.,National Reference Center of Rare Urinary Tract Malformations (MARVU), Paris, France
| | - Alaa El-Ghoneimi
- Department of Pediatric Urology, Robert-Debré University Hospital, Assistance Publique - Hôpitaux de Paris (APHP), Paris, France.,National Reference Center of Rare Urinary Tract Malformations (MARVU), Paris, France.,University of Paris, Paris, France
| |
Collapse
|
6
|
Comparison of open, laparoscopic and robot-assisted pyeloplasty for pelviureteric junction obstruction in adult patients. J Robot Surg 2019; 14:325-329. [PMID: 31222624 DOI: 10.1007/s11701-019-00991-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Accepted: 06/17/2019] [Indexed: 10/26/2022]
Abstract
Ureteropelvic junction obstruction (UPJO) is a frequently found congenital abnormality of the upper urinary tract treated with pyeloplasty. We hereby report a study to compare open pyeloplasty (OP), laparoscopic pyeloplasty (LP) and robotic assisted pyeloplasty (RAP) for UPJO in terms of functional and perioperative outcomes. 102 patients who underwent Anderson-Hynes dismembered pyeloplasty for UPJO were divided into three groups based on type of surgical techniques utilized as follows: OP (Group A; n = 34), LP (Group B; n = 34), and RAP (Group C; n = 34). Preoperative, intraoperative and postoperative data were recorded. The mean operative time was significantly more in the Group B (187.76 min) than the Group A (132.06 ± 30.1 min) and Group C (136.76 ± 25.1 min) (p < .001). Mean blood loss was more in OP group 86.47 ± 29. 35 ml versus 42.94 ± 20. 77 ml in RAP and 45.59 ± 20. 3 ml in the LP group (p < .001). The LP was found to be much tiring. Mean surgeon fatigue index (SFI) calculated was 7 ± 1.1 in the LP group compared to 4.12 ± 1.1 in RAP group and the difference was statistically significant (p< .001). Average VAS score in the first 2 days postoperatively was 6.66±1.58 in the OP group compared to 4.29 ± 1.16 in RAP group and 4.29 ± 1.31 in the LP group (p < 0.001). Pyeloplasty has a similar success rate and efficacy irrespective of the technique utilized. RAP improves the surgeons QOL (quality of life) and the fatigue scores, which is useful for surgeon longevity. RAP has become widely favorite and can be considered the approach of choice in the management of UPJO wherever infrastructure and finances allow.
Collapse
|
7
|
Luk ACO, Pandian RMK, Heer R. Laparoscopic renal surgery is here to stay. Arab J Urol 2018; 16:314-320. [PMID: 30140467 PMCID: PMC6104665 DOI: 10.1016/j.aju.2018.01.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Accepted: 01/23/2018] [Indexed: 01/20/2023] Open
Abstract
Objectives To review the current literature comparing the outcomes of renal surgery via open, laparoscopic and robotic approaches. Materials and methods A comprehensive literature search was performed on PubMed, MEDLINE and Ovid, to look for studies comparing outcomes of renal surgery via open, laparoscopic, and robotic approaches. Results Limited good-quality evidence suggests that all three approaches result in largely comparable functional and oncological outcomes. Both laparoscopic and robotic approaches result in less blood loss, analgesia requirement, with a shorter hospital stay and recovery time, with similar complication rates when compared with the open approach. Robotic renal surgeries have not shown any significant clinical benefit over a laparoscopic approach, whilst the associated cost is significantly higher. Conclusion With the high cost and lack of overt clinical benefit of the robotic approach, laparoscopic renal surgery will likely continue to remain relevant in treating various urological pathologies.
Collapse
Key Words
- (L)(LESS-)DN, (laparoscopic) (laparoendoscopic single-site-) donor nephrectomy
- (L)(O)(RA)PN, (laparoscopic) (open) (robot-assisted) partial nephrectomy
- (L)(O)(RA)PY, (laparoscopic) (open) (robot-assisted) pyeloplasty
- (L)(O)(RA)RN, (laparoscopic) (open) (robot-assisted) radical nephrectomy
- BMI, body mass index
- Donor nephrectomy
- LOS, length of hospital stay
- Laparoscopic/open/robotic renal surgery
- NOTES, natural orifice transluminal endoscopic surgery
- PUJO, PUJ obstruction
- Partial nephrectomy
- Pyeloplasty
- RCT, randomised controlled trial
- Radical nephrectomy
- WIT, warm ischaemia time
- eGFR, estimated GFR
Collapse
Affiliation(s)
- Angus Chin On Luk
- Department of Urology, Freeman Hospital, High Heaton, Newcastle upon Tyne, UK
| | | | - Rakesh Heer
- Department of Urology, Freeman Hospital, High Heaton, Newcastle upon Tyne, UK
| |
Collapse
|
8
|
Abstract
Laparoscopic pyeloplasty (LP) is more beneficial than open procedures. However, studies on laparoscopic management of cases with secondary ureteropelvic junction obstruction (SUPJO) after previous failed pyeloplasty in the pediatric population are lacking. This meta-analysis aimed to assess the difference between redo LP (RLP) and redo open pyeloplasty (ROP) for children with SUPJO, focusing on certain criteria. All recent studies on RLP and ROP in children with SUPJO were searched. Search engines such as Medline, PubMed, and The Cochrane Library of Systematic Reviews were used. Sixty citations were specified. Two reviewers extracted data independently, screened the titles, and assessed the quality of each citation. Continuous data reported as a weighted mean difference (WMD) (95% confidence interval) and dichotomous data reported as relative risk were used. We measured the length of hospital stay (LOS) and operative time using weighted mean and success and complication rates using risk difference and odds ratio (OR). A random effects model was used to pool OR that was tested for heterogeneity. We specified six publications that minutely met our eligibility standards. Meta-analysis of given data resulted in the following: ROP showed reduction in operative time by 12 min (WMD: 12.7 min; P = 0.14). RLP had shorter LOS than ROP (WMD: 0.6 days; P < 0.01). No difference was observed in complication and success rates (OR: 0.8; P = 0.50 and OR: 1.2; P = 0.51, respectively). In conclusion, RLP seems to be better than ROP in terms of LOS reduction; however, both are comparable with respect to success and complication rates, especially postoperative urine leakage.
Collapse
Affiliation(s)
- Hamdan Hammad Alhazmi
- Department of Surgery, Division of Urology, College of Medicine and King Saud University Medical City, King Saud University, Riyadh, Kingdom of Saudi Arabia
| |
Collapse
|
9
|
Laparoscopic Pyeloplasty for Ureteropelvic Junctions Obstruction in Adults: 6 Years' Experience in One Center. BIOMED RESEARCH INTERNATIONAL 2017; 2017:6743512. [PMID: 28691029 PMCID: PMC5485285 DOI: 10.1155/2017/6743512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Revised: 03/07/2017] [Accepted: 04/26/2017] [Indexed: 11/17/2022]
Abstract
Objective Ureteropelvic junction obstruction (UPJO) is a common cause of symptomatic ureteral obstruction. The aim of this study is to assess the outcome of laparoscopic pyeloplasty in patients with UPJO. Patients and Methods Medical reports of 47 UPJO patients treated with laparoscopic pyeloplasty were retrospectively analysed. All patients were recruited from our center in the period 2004–2011. Results We evaluated 47 patients. Mean age was 36 years and mean hospital stay 3.6 days. 42 (79%) of the patients had pain and 46 (98%) were diagnosed with hydronephrosis. 19 patients (40%) had a renal function below 40% of the affected kidney and 49% had impaired renal scan drainage. Postoperative significant improvement in pain score and renal scan drainage was found in 92% and 47% of the patients, respectively. Improvement of renal function > 10% was found in 11 patients (23%); the function remained stable in 31 patients (66%) and deteriorated > 10% in 5 patients (11%). We found no correlation between sex or age and the outcome. Conclusion Laparoscopic pyeloplasty for UPJO leads to relief of pain and preserved or improved renal function in the majority of the patients. Overall laparoscopic pyeloplasty is an efficient treatment for UPJO.
Collapse
|
10
|
Gatti JM, Amstutz SP, Bowlin PR, Stephany HA, Murphy JP. Laparoscopic vs Open Pyeloplasty in Children: Results of a Randomized, Prospective, Controlled Trial. J Urol 2017; 197:792-797. [DOI: 10.1016/j.juro.2016.10.056] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/11/2016] [Indexed: 12/25/2022]
|
11
|
Lai WR, Stewart CA, Thomas R. Technology Based Treatment for UreteroPelvic Junction Obstruction. J Endourol 2016; 31:S59-S63. [PMID: 27549028 DOI: 10.1089/end.2016.0592] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Surgical management of ureteropelvic junction obstruction (UPJO) has historically been performed with open pyeloplasty. With the advent of endourology, laparoscopy, and robotics, minimally-invasive techniques have been described and accepted as alternatives to open surgery. Each of these approaches has its own advantages and disadvantages, equipment needs, degree of invasiveness, and experience of the treating urologist. Advocates and critics have their own say as to their preferred technique. In this article, we review the chronological evolution of these techniques and discuss their current role in the management of UPJO.
Collapse
Affiliation(s)
- Weil R Lai
- Department of Urology, Tulane University School of Medicine , New Orleans, Louisiana
| | - Carrie A Stewart
- Department of Urology, Tulane University School of Medicine , New Orleans, Louisiana
| | - Raju Thomas
- Department of Urology, Tulane University School of Medicine , New Orleans, Louisiana
| |
Collapse
|
12
|
|
13
|
|
14
|
Başataç C, Boylu U, Önol FF, Gümüş E. Comparison of surgical and functional outcomes of open, laparoscopic and robotic pyeloplasty for the treatment of ureteropelvic junction obstruction. Turk J Urol 2015; 40:24-30. [PMID: 26328141 DOI: 10.5152/tud.2014.06956] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2013] [Accepted: 12/04/2013] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To compare the surgical and functional outcomes of open, laparoscopic and robotic dismembered pyeloplasty for the treatment of patients with ureteropelvic junction obstruction (UPJO). MATERIAL AND METHODS Between 2007 and 2012, a total of 56 patients underwent conventional open (Group 1; n=25), laparoscopic (Group 2; n=16), and robotic (Group 3; n=15) dismembered pyeloplasty operations. Preoperative evaluation was performed using urinalysis, urine culture, blood biochemistry, urinary ultra-sound, intravenous pyelogram (IVP) (optional) and Mercaptoacetyltriglycine (MAG-3) renal scan. The mean operation time, estimated blood loss, drain removal time, narcotic analgesic requirements, length of hospital stay and functional outcomes were compared among groups. Statistical analyses were performed using Statistical Package for the Social Sciences (SPSS) v. 20 (IBM, Armonk, NY, USA) software, and statistically significant differences were determined using a p value <0.05. RESULTS The mean age of the patients was 30 years in Group 1, 34.3 years in Group 2 and 32.9 years in Group 3. The mean operation time was 127, 130 and 114 min (p=0.32), and the estimated blood loss was 105, 31 and 28 mL, respectively (p=0.001). The drain was removed after 4.36 (±1.3), 2.33 (±0.6) and 1.8 (±0.6) days after surgery (p<0.001), and the mean hospital stay was 4.14 (±1.8), 2.8 (±0.75) and 2 (±1) days, respectively (p<0.001). Narcotic analgesic requirement was significantly higher in Group 1 compared with Groups 2 and 3 (p=0.02). The radiographic and symptomatic success rates were 96% in Group 1, 93.75% in Group 2 and 93.3% in Group 3. CONCLUSION Laparoscopic and robotic pyeloplasty are feasible, effective, reliable and minimally invasive treatment approaches for the treatment of UPJO as compared with open dismembered pyeloplasty.
Collapse
Affiliation(s)
- Cem Başataç
- Depatment of Urology, Ümraniye Teaching Hospital, İstanbul, Turkey
| | - Uğur Boylu
- Depatment of Urology, Ümraniye Teaching Hospital, İstanbul, Turkey
| | | | - Eyüp Gümüş
- Depatment of Urology, Ümraniye Teaching Hospital, İstanbul, Turkey
| |
Collapse
|
15
|
Ekin RG, Celik O, Ilbey YO. An up-to-date overview of minimally invasive treatment methods in ureteropelvic junction obstruction. Cent European J Urol 2015; 68:245-51. [PMID: 26251754 PMCID: PMC4526614 DOI: 10.5173/ceju.2015.543] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Revised: 03/15/2015] [Accepted: 04/18/2015] [Indexed: 12/20/2022] Open
Abstract
Introduction Over the last two decades, minimally invasive treatment options for ureteropelvic junction obstruction have been developed and are bcoming more popular. Multiple series of laparoscopic pyeloplasty have demonstrated high success rates and low perioperative morbidity in pediatric and adult populations, for both the transperitoneal and retroperitoneal approaches. In this review, we aimed to analyze the current status of minimally invasive therapy of ureteropelvic junction obstruction. Material and methods A PubMed database search was conducted to examine minimally invasive treatments of ureteropelvic junction obstruction. Results A large number of cases have been reported for adult patients, confirming that robotic pyeloplasty represents a viable option for either primary or secondary repair. Comparative studies demonstrate similar success and complication rates between minimally invasive and open pyeloplasty in both the adult and pediatric populations. A clear advantage, in terms of hospital stay, of minimally invasive over open pyeloplasty was observed only in the adult population. Conclusions Studies have shown that minimally invasive pyeloplasty techniques are a safe, effective, and feasible in adult and pediatric populations.
Collapse
Affiliation(s)
- Rahmi Gokhan Ekin
- Tepecik Teaching and Research Hospital, Department of Urology, Izmir, Turkey
| | - Orcun Celik
- Tepecik Teaching and Research Hospital, Department of Urology, Izmir, Turkey
| | - Yusuf Ozlem Ilbey
- Tepecik Teaching and Research Hospital, Department of Urology, Izmir, Turkey
| |
Collapse
|
16
|
Simforoosh N, Abedi A, Hosseini Sharifi SH, Poor Zamany N K M, Rezaeetalab GH, Obayd K, Soltani MH. Comparison of surgical outcomes and cosmetic results between standard and mini laparoscopic pyeloplasty in children younger than 1 year of age. J Pediatr Urol 2014; 10:819-23. [PMID: 24613142 DOI: 10.1016/j.jpurol.2014.01.026] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2013] [Accepted: 01/29/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To evaluate safety, efficacy, and cosmetic results after mini laparoscopic (mL) pyeloplasty and standard (sL) pyeloplasty in children younger than 1 year of age with ureteropelvic junction obstruction (UPJO). MATERIALS AND METHODS From August 2009 to March 2011, 20 sL pyeloplasties were performed in pediatric patients younger than 1 year of age; afterwards, 20 patients younger than 1 year of age underwent mini laparoscopic (mL) pyeloplasty from June 2011 to August 2012. The patients were followed by urine culture and ultrasonography at 3 and 6 months after surgery. Cosmetic appearance was assessed in all patients in both groups group 3 months after surgery using the Patient Scar Assessment Questionnaire. RESULTS Peri and postoperative results revealed that operative time (total and anastomosis of ureteropelvic junction), hospital stay, and overall complication rate were significantly lower in mL than in sL. Persistent hydronephrosis in follow-up imaging and recurrence of obstruction was not observed in any cases. Mean appearance score and consciousness score showed significantly better results in the mL group. CONCLUSION We believe that mL pyeloplasty in infant cases with UPJO is more cosmetically pleasing and less invasive than sL pyeloplasty and has similar functional outcomes.
Collapse
Affiliation(s)
- N Simforoosh
- Shahid Labbafinejad Medical Center, Urology and Nephrology Research Center, Shahid Beheshti University of Medical Sciences, No. 99, 9th Boostan, Pasdaran Avenue, Tehran, Iran
| | - A Abedi
- Shahid Labbafinejad Medical Center, Urology and Nephrology Research Center, Shahid Beheshti University of Medical Sciences, No. 99, 9th Boostan, Pasdaran Avenue, Tehran, Iran
| | - S H Hosseini Sharifi
- Shahid Labbafinejad Medical Center, Urology and Nephrology Research Center, Shahid Beheshti University of Medical Sciences, No. 99, 9th Boostan, Pasdaran Avenue, Tehran, Iran
| | - M Poor Zamany N K
- Shahid Labbafinejad Medical Center, Urology and Nephrology Research Center, Shahid Beheshti University of Medical Sciences, No. 99, 9th Boostan, Pasdaran Avenue, Tehran, Iran
| | - G H Rezaeetalab
- Shahid Labbafinejad Medical Center, Urology and Nephrology Research Center, Shahid Beheshti University of Medical Sciences, No. 99, 9th Boostan, Pasdaran Avenue, Tehran, Iran
| | - K Obayd
- Shahid Labbafinejad Medical Center, Urology and Nephrology Research Center, Shahid Beheshti University of Medical Sciences, No. 99, 9th Boostan, Pasdaran Avenue, Tehran, Iran
| | - M H Soltani
- Shahid Labbafinejad Medical Center, Urology and Nephrology Research Center, Shahid Beheshti University of Medical Sciences, No. 99, 9th Boostan, Pasdaran Avenue, Tehran, Iran.
| |
Collapse
|
17
|
Samarasekera D, Stein RJ. Robotic-assisted laparoscopic approaches to the ureter: Pyeloplasty and ureteral reimplantation. Indian J Urol 2014; 30:293-9. [PMID: 25097316 PMCID: PMC4120217 DOI: 10.4103/0970-1591.128503] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
INTRODUCTION AND OBJECTIVES The benefits of robotic surgery when compared to standard laparoscopy have been well established, especially when it comes to reconstructive procedures. The application of robotic technology to laparoscopic pyeloplasty has reduced the steep learning curve associated with the procedure. Consequently, this has allowed surgeons who are less experienced with laparoscopy to offer this treatment to their patients, instead of referring them to centers of excellence. Robotic pyeloplasty has also proved useful for repairing secondary UPJO, a procedure which is considered extremely difficult using a conventional laparoscopic approach. Finally, the pursuit of scarless surgery has seen the development of laparoendoscopic single site (LESS) procedures. The application of robotics to LESS (R-LESS) has also reduced the difficulty in performing conventional LESS pyeloplasty. Herein we present a literature review with regards to robotic-assisted laparoscopic pyeloplasty. We also discuss the benefits of robotic surgery with regards to reconstruction of the lower urinary tract. MATERIALS AND METHODS A systematic literature review was performed using PubMed to identify relevant studies. There were no time restrictions applied to the search, but only studies in English were included. We utilized the following search terms: Ureteropelvic junction obstruction and laparoscopy; laparoscopic pyeloplasty; robotic pyeloplasty; robotic ureteric reimplantation; robotic ureteroneocystostomy; robotic boari flap; robotic psoas hitch. RESULTS There has been considerable experience in the literature with robotic pyeloplasty. Unfortunately, no prospective randomized studies have been conducted, however there are a number of meta analyses and systematic reviews. While there are no clear benefits when it comes to surgical and functional outcomes when compared to standard laparoscopic pyeloplasty, it is clear that robotics makes the operation easier to perform. There is also a benefit to the robotic approach when performing a redo-pyeloplasty. Robotic pyeloplasty has also been applied to the pediatric population, and there may be a benefit in older children while in very young patients, retroperitoneal open pyeloplasty is still the gold standard. In the field of single incision surgery R-LESS is technically easier to perform than conventional LESS. However, the design of the current robotic platform is not completely suited for this application, limiting its utility and often requiring a larger incision. Optimized R-LESS specific technology is awaited. What is clear, from a number of analyses, is that robotic pyeloplasty is considerably more expensive than the laparoscopic approach, largely due to costs of instrumentation and the capital expense of the robot. Until cheaper robotic technology is available, this technique will continue to be expensive, and a cost-benefit analysis must be undertaken by each hospital planning to undertake this surgery. Finally, the benefits of upper tract reconstruction apply equally to the lower tract although there is considerably less experience. However, there have been a number of studies demonstrating the technical feasibility of ureteral reimplantation. CONCLUSIONS Robotic-assisted laparoscopic pyeloplasty is gaining popularity, likely due to the shorter learning curve, greater surgeon comfort, and easier intracorporeal suturing. This has allowed more surgeons to perform the procedure, improving accessibility. Robotic technology is also beneficial in the field of LESS. Nevertheless, the procedure still is not as cost-effective as the conventional laparoscopic approach, and until more affordable robotic technology is available, it will not be universally offered.
Collapse
Affiliation(s)
- Dinesh Samarasekera
- Department of Urology, Glickman Urologic and Kidney Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Robert J Stein
- Department of Urology, Glickman Urologic and Kidney Institute, Cleveland Clinic, Cleveland, Ohio, USA
| |
Collapse
|
18
|
Garg M, Singh V, Sinha RJ, Sankhwar SN. Prospective Randomized Comparison of Retroperitoneoscopic vs Open Pyeloplasty With Minimal Incision: Subjective and Objective Assessment in Adults. Urology 2014; 83:805-11. [DOI: 10.1016/j.urology.2013.11.024] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2013] [Revised: 11/09/2013] [Accepted: 11/20/2013] [Indexed: 10/25/2022]
|
19
|
Bhandarkar D. Simultaneous submission leading to duplicate publication: Scientific misconduct rears its ugly head. J Minim Access Surg 2013; 9:147-8. [PMID: 24250057 PMCID: PMC3830130 DOI: 10.4103/0972-9941.118821] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2013] [Accepted: 09/05/2013] [Indexed: 11/30/2022] Open
Affiliation(s)
- Deepraj Bhandarkar
- Department of Minimal Access Surgery, Hinduja Hospital, Mahim, Mumbai, India
| |
Collapse
|
20
|
Autorino R, Eden C, El-Ghoneimi A, Guazzoni G, Buffi N, Peters CA, Stein RJ, Gettman M. Robot-assisted and laparoscopic repair of ureteropelvic junction obstruction: a systematic review and meta-analysis. Eur Urol 2013; 65:430-52. [PMID: 23856037 DOI: 10.1016/j.eururo.2013.06.053] [Citation(s) in RCA: 137] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2013] [Accepted: 06/26/2013] [Indexed: 12/15/2022]
Abstract
CONTEXT Over the last two decades, minimally invasive treatment options for ureteropelvic junction obstruction (UPJO) have been developed and popularized. OBJECTIVE To critically analyze the current status of laparoscopic and robotic repair of UPJO. EVIDENCE ACQUISITION A systematic literature review was performed in November 2012 using PubMed. Article selection proceeded according to the search strategy based on Preferred Reporting Items for Systematic Reviews and Meta-analyses criteria. EVIDENCE SYNTHESIS Multiple series of laparoscopic pyeloplasty have demonstrated high success rates and low perioperative morbidity in pediatric and adult populations, with both the transperitoneal and retroperitoneal approaches. Data on pediatric robot-assisted pyeloplasty are increasingly becoming available. A larger number of cases have also been reported for adult patients, confirming that robotic pyeloplasty represents a viable option for either primary or secondary repair. Robot-assisted redo pyeloplasty has been mostly described in the pediatric population. Different technical variations have been implemented with the aim of tailoring the procedure to each specific case. The type of stenting, retrograde versus antegrade, continues to be debated. Internal-external stenting as well as a stentless approach have been used, especially in the pediatric population. Comparative studies demonstrate similar success and complication rates between minimally invasive and open pyeloplasty in both the adult and pediatric setting. A clear advantage in terms of hospital stay for minimally invasive over open pyeloplasty was observed only in the adult population. CONCLUSIONS Laparoscopy represents an efficient and effective less invasive alternative to open pyeloplasty. Robotic pyeloplasty is likely to emerge as the new minimally invasive standard of care whenever robotic technology is available because its precise suturing and shorter learning curve represent unique attractive features. For both laparoscopy and robotics, the technique can be tailored to the specific case according to intraoperative findings and personal surgical experience.
Collapse
Affiliation(s)
- Riccardo Autorino
- Glickman Urological & Kidney Institute, Cleveland Clinic, Cleveland, OH, USA; Urology Service, Second University of Naples, Naples, Italy.
| | - Christopher Eden
- Department of Urology, Royal Surrey County Hospital, Guildford, UK
| | - Alaa El-Ghoneimi
- Department of Pediatric Surgery and Urology, Hôpital Robert Debré, Assistance Publique-Hopitaux de Paris, University of Paris Diderot, Paris, France
| | - Giorgio Guazzoni
- Department of Urology, Vita-Salute University, San Raffaele-Turro Hospital, Milan, Italy
| | - Nicolòmaria Buffi
- Department of Urology, Vita-Salute University, San Raffaele-Turro Hospital, Milan, Italy
| | - Craig A Peters
- Department of Pediatric Surgery, Children's National Medical Center, Washington, DC, USA
| | - Robert J Stein
- Glickman Urological & Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | | |
Collapse
|