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Zhao P, Wang C, Mao K, Luo Z, Li Y, Zhou G, Tan H, Liu H, Mao Y, Ma H, Shang X, Liu B. Comparative study of different surgical approaches for treatment of UPJ obstruction according to the degree/severity of hydronephrosis factor. Front Pediatr 2022; 10:966292. [PMID: 35989992 PMCID: PMC9386036 DOI: 10.3389/fped.2022.966292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 07/18/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To compare the efficacy of two different surgical approaches during and after pyeloplasty according to the degree/severity of hydronephrosis factor. MATERIALS AND METHODS Sixty child patients with UPJ obstruction admitted to our hospital from August 2019 to October 2021 were collected. Patients who underwent retroperitoneal laparoscopic pyeloplasty (RPLP) were enrolled into Group A (n = 20), while those who received transperitoneal laparoscopic pyeloplasty (TLP) were selected as Group B (n = 40). Clinical parameters, including gender, age, laterality of UPJ obstruction, degree/severity of hydronephrosis, body weight, operation time, drainage tube indwelling time, complete oral feeding time, and length of hospital stay, were compared between the two groups. RESULTS All 60 child patients were operated upon successfully without conversion to open surgery. There were no statistically significant differences in gender, age, laterality of UPJ obstruction, and body weight between the two groups, while the operation time of TLP was shorter than that of RPLP, indicating a statistically significant difference (P < 0.001). The differences in complete oral feeding time, drainage tube indwelling time, and length of hospital stay were statistically significant between the two groups, and RPLP was superior to TLP in terms of postoperative recovery time (P < 0.001). A stratified comparison showed that there were no statistically significant differences in anteroposterior diameter ≤ 20 mm, while there were statistically significant differences in anteroposterior diameter >20 mm. Hydronephrosis is reviewed after 3 months of the operation, degree/severity of hydronephrosis have been reduced. CONCLUSION Both RPLP and TLP are safe and feasible in the treatment of UPJ obstruction, and their overall surgical effects are equivalent. For child patients with anteroposterior diameter ≤ 20 mm, RPLP is available, while patients with anteroposterior diameter >20 mm, TLP is recommended.
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Affiliation(s)
- Peng Zhao
- Guizhou Children's Hospital, Zunyi, China.,Department of Pediatric Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Cao Wang
- Guizhou Children's Hospital, Zunyi, China.,Department of Pediatric Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Kaiyi Mao
- Guizhou Children's Hospital, Zunyi, China.,Department of Pediatric Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Zhen Luo
- Guizhou Children's Hospital, Zunyi, China.,Department of Pediatric Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Yingbo Li
- Guizhou Children's Hospital, Zunyi, China.,Department of Pediatric Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Guangxu Zhou
- Guizhou Children's Hospital, Zunyi, China.,Department of Pediatric Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Hongyang Tan
- Guizhou Children's Hospital, Zunyi, China.,Department of Pediatric Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Hong Liu
- Guizhou Children's Hospital, Zunyi, China.,Department of Pediatric Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Yucheng Mao
- Guizhou Children's Hospital, Zunyi, China.,Department of Pediatric Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Hong Ma
- Guizhou Children's Hospital, Zunyi, China.,Department of Pediatric Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Xianhui Shang
- Guizhou Children's Hospital, Zunyi, China.,Department of Pediatric Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Bin Liu
- Guizhou Children's Hospital, Zunyi, China.,Department of Pediatric Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi, China
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Wahyudi I, Tendi W, Rahman F, Situmorang GR, Rodjani A. Minimal Invasive Treatment in Pelvic-Ureteric Junction Obstruction: A Comprehensive Review. Res Rep Urol 2021; 13:573-580. [PMID: 34408990 PMCID: PMC8364382 DOI: 10.2147/rru.s268569] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Accepted: 07/27/2021] [Indexed: 12/22/2022] Open
Abstract
Pelvic-ureteric junction obstruction (PUJO) is a common condition, and one of the lead causes of hydronephrosis in children. Currently, the gold standard treatment of PUJO is open surgery using the Anderson–Hynes-modified dismembered pyeloplasty technique. However, with the advancement of medical technology, several minimal invasive approaches were developed, including endoscopic, laparoscopic, and robotic approach, from which the best choice of surgical technique was yet to be determined. Considering the advantages and disadvantages of these methods, the recommended option is to tailor the best surgical approach to each individual patient, and to the surgeons’ preference and experience. Considering these recent advances, a new algorithm is proposed to choose the best minimal invasive modalities invasive treatment to treat PUJO.
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Affiliation(s)
- Irfan Wahyudi
- Department of Urology, Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia.,Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - William Tendi
- Department of Urology, Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia.,Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Fakhri Rahman
- Department of Urology, Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia.,Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Gerhard Reinaldi Situmorang
- Department of Urology, Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia.,Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Arry Rodjani
- Department of Urology, Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia.,Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
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Abstract
Uretero-pelvic junction obstruction (UPJO) is the most common cause of hydronephrosis in infants and children. Historically, this condition has been approached surgically through a retroperitoneal approach as described by Anderson and Hynes aiming for an open dismembered pyeloplasty. A true evolution of laparoscopy in pediatric urology took place within the last 30 years. Laparoscopy developed from a merely diagnostic tool for non-palpable testes to "interventional" laparoscopy for extirpative surgery. Finally the era of reconstructive pediatric laparoscopic urology started, when in 1995 Peters described the first laparoscopic pyeloplasty in a child. Laparoscopic dismembered pyeloplasty now has become the preferred surgical treatment of UPJO. It offers excellent visualization of the anatomy, accurate anastomotic suturing, thus the precise reconstruction of the UPJ along with good functional outcome. This article aims to provide the current status, indication and operative technique of laparoscopic dismembered pyeloplasty for UPJO in infants and children.
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Affiliation(s)
- Philipp Szavay
- Department of Pediatric Surgery, Lucerne Children's Hospital, Luzern, Spitalstrasse 6000, Switzerland.
| | - Sabine Zundel
- Department of Pediatric Surgery, Lucerne Children's Hospital, Luzern, Spitalstrasse 6000, Switzerland
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Kang SK, Jang WS, Kim SW, Kim SH, Han SW, Lee YS. Robot-assisted laparoscopic single-port pyeloplasty using the da Vinci SP® system: initial experience with a pediatric patient. J Pediatr Urol 2019; 15:576-577. [PMID: 31570233 DOI: 10.1016/j.jpurol.2019.08.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Accepted: 08/04/2019] [Indexed: 10/26/2022]
Abstract
INTRODUCTION The da Vinci SP® Robotic Surgical Platform (Intuitive Surgical) was recently introduced to overcome triangulation and motion restriction during laparoendoscopic single-site surgery. The authors describe a pure, single-site, robot-assisted, laparoscopic pyeloplasty (RALP) using the da Vinci SP System in a pediatric patient. MATERIAL AND METHODS A 10-year-old patient with ureteropelvic junction obstruction underwent pyeloplasty conducted using the da Vinci SP® System. Retrospective perioperative and immediate postoperative outcomes were investigated. RESULTS Surgery was completed with pure single-site surgery without additional port placement or standard multiport conversion. The total operation time was 211 min, and the console time was 90 min. The docking time was much greater than that of previous pyeloplasty operations using multiport system. This result may be because of difficulties caused by bulky instrumentation entering the pneumoperitoneum. The estimated blood loss was minor, and there were no intraoperative or perioperative complications. Ureteral stent was removed after 4 weeks. Cosmetic outcomes were satisfactory. CONCLUSIONS Pure, single-site RALP using da Vinci SP® System seems feasible in aging children. Additional studies involving more patients, younger children, and long-term outcomes are required.
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Affiliation(s)
- Sung Ku Kang
- Department of Urology, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Won Sik Jang
- Department of Urology, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sang Woon Kim
- Department of Urology, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sung Hoon Kim
- Department of Pediatric Urology, Severance Children's Hospital, Seoul, Republic of Korea
| | - Sang Won Han
- Department of Urology, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Yong Seung Lee
- Department of Urology, Yonsei University College of Medicine, Seoul, Republic of Korea.
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丁 光, 程 嗣, 方 冬, 杨 昆, 李 学, 周 辉, 张 骞, 叶 雄, 周 利. [Review of upper urinary modified minimal invasive surgical technology]. BEIJING DA XUE XUE BAO. YI XUE BAN = JOURNAL OF PEKING UNIVERSITY. HEALTH SCIENCES 2019; 51:610-614. [PMID: 31420609 PMCID: PMC7433496 DOI: 10.19723/j.issn.1671-167x.2019.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Indexed: 11/20/2022]
Abstract
Upper urinary surgery is an important area of urology surgery. Open surgery used to be the gold standard of upper urinary surgery. With the development of medical techniques, minimal invasive surgeries including laparoscopic and robot assisted-laparoscopic surgery have gradually replaced the open surgery. Because of the complexity and diversity of upper urinary diseases, surgeries sometimes are difficult, and minimal invasive surgeries require higher surgical abilities of urologists than open surgeries. In recent years, depending on our surgical experience and international reports, our team from three Chinese medical centers summarizes techniques of upper urinary minimal invasive surgeries. For malignant diseases, such as renal and ureteral carcinomas, it's important to totally remove the tumor first, and then to avoid the surgical injuries. We summarize surgical experience of retroperitoneal laparoscopic partial nephrectomy for moderately complex renal hilar tumors. Our team modified minimal invasive techniques for some complex tumors, including ring suture technique for renal hilar tumors, internal suspension technique for renal ventral tumors, and combination retroperitoneal laparoscopic surgery with mini-flank incision for complex renal tumors. While for begin diseases, urologists should focus on the resections and surgical injuries at the same time. We have reported the novel technique of laparoscopic aspiration for central renal angiomyolipoma, making the surgery simple and available. For reconstruction surgeries, operations should be based on several principals. We generalize it as "4TB principals", which include "tension-free", "water-tight", "thin suture", "no touch of the key area" and "protecting the blood supply". Depending on the localization, length, and etiology of the strictures, different techniques are required. Our team summarize the pyeloplasty, ureteral reimplantation and ileal ureter replacement based on our surgical experience. For infant upper urinary surgeries, our team has made invasive surgeries that can be used in complex diseases, such as duplex kidney. Based on years of surgical techniques, our modified surgeries achieve a better subjective cosmetic result than the traditional surgeries. In the future, the standardized, practical, simple and individual minimal invasive surgical technique will become the main direction in the future researches.
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Affiliation(s)
- 光璞 丁
- 北京大学第一医院泌尿外科, 北京 100034Department of Urology, Peking University First Hospital, Beijing 100034, China
| | - 嗣达 程
- 北京大学第一医院泌尿外科, 北京 100034Department of Urology, Peking University First Hospital, Beijing 100034, China
| | - 冬 方
- 北京大学第一医院泌尿外科, 北京 100034Department of Urology, Peking University First Hospital, Beijing 100034, China
| | - 昆霖 杨
- 北京大学第一医院泌尿外科, 北京 100034Department of Urology, Peking University First Hospital, Beijing 100034, China
| | - 学松 李
- 北京大学第一医院泌尿外科, 北京 100034Department of Urology, Peking University First Hospital, Beijing 100034, China
| | - 辉霞 周
- 中国人民解放军总医院第七医学中心八一儿童医院泌尿外科, 北京 100700Department of Pediatric Urology, Bayi Children’s Hospital Affiliated to The Seventh Medical Center of Chinese PLA General Hospital, No 5 Nanmencang, Beijing, 100700, China
| | - 骞 张
- 北京大学第一医院泌尿外科, 北京 100034Department of Urology, Peking University First Hospital, Beijing 100034, China
| | - 雄俊 叶
- 北京大学人民医院泌尿外科, 北京 100044Department of Urology, Peking University People’s Hospital, Beijing 100044, China
| | - 利群 周
- 北京大学第一医院泌尿外科, 北京 100034Department of Urology, Peking University First Hospital, Beijing 100034, China
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Szavay PO. Applications of Laparoscopic Transperitoneal Surgery of the Pediatric Urinary Tract. Front Pediatr 2019; 7:29. [PMID: 30805327 PMCID: PMC6378287 DOI: 10.3389/fped.2019.00029] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Accepted: 01/23/2019] [Indexed: 12/23/2022] Open
Abstract
Application of laparoscopy in pediatric urology has evolved over more than 30 years coming from a merely diagnostic use for non-palpable testes to "interventional" laparoscopy to extirpative surgery and finally to the era of reconstructive pediatric laparoscopic urology, when in 1995 Peters described the first laparoscopic pyeloplasty in a child. Laparoscopic surgery in pediatric urology became implemented increasingly in the twenty-first century with now present-day applications including the complete variety of all kind of indications for surgery for pediatric urological pathology. This article aims to provide a comprehensive overview of current indications, techniques, and outcomes of laparoscopic transperitoneal surgery of the upper as well as of the lower urinary tract for urological pathology in the pediatric patient population.
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Affiliation(s)
- Philipp O Szavay
- Department of Pediatric Surgery, Lucerne Children's Hospital, Lucerne, Switzerland
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Liu D, Zhou H, Hao X, Cao H, Ma L, Zhou X, Tao T, Cheng W, Feng Z. Laparoscopic Yang-Monti Ureteral Reconstruction in Children. Urology 2018; 118:177-182. [PMID: 29751025 DOI: 10.1016/j.urology.2018.04.034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Revised: 04/24/2018] [Accepted: 04/27/2018] [Indexed: 10/17/2022]
Abstract
OBJECTIVE To investigate the clinical outcome of surgical treatment for long ureteral defect in children, we evaluated our experience of managing 6 children with the long defect utilizing laparoscopic ureteral reconstruction technique using Yang-Monti technique. MATERIALS AND METHODS Six children with long ureteral defect who underwent laparoscopic Yang-Monti ureteral reconstruction between January 2013 and March 2016 were reviewed. The diagnosis and outcomes of long ureteral defects were reviewed based on clinical and imaging data. We assessed preoperative clinical data and outcomes, and analyzed the experience of laparoscopic Yang-Monti ureteral reconstruction. RESULTS The mean age of the patients was 8.5 years. The etiology of the ureteral defect was failed pyeloplasty in 4 patients, failed pyeloplasty and ureteral reimplantation in 1, and trauma in 1. The mean defect length was 5.83 cm. All operations were performed successfully with no serious intraoperative complications and no conversion. The average operative time was 314 minutes, the average intraoperative blood loss was 25 mL, the average drain removal was 3.83 days, the average start of oral feeding was 5.17 days, and the average postoperative hospital stay was 7.17 days. Six patients suffered Clavien I and II complications postoperatively and were managed conservatively. Two patients suffered Clavien III complications postoperatively and were managed by replacing stent. A diuretic T1/2 showed the improvement of differential renal function without urinary obstruction in all patients. CONCLUSION Laparoscopic Yang-Monti ureteral reconstruction is safe and feasible in children with an excellent outcome.
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Affiliation(s)
- Dehong Liu
- Department of Pediatric Urology, Bayi Children's Hospital Affiliated to PLA Army General Hospital, Beijing, China
| | - Huixia Zhou
- Department of Pediatric Urology, Bayi Children's Hospital Affiliated to PLA Army General Hospital, Beijing, China.
| | - Xuemei Hao
- Department of Anesthesiology, PLA Army General Hospital, Beijing, China
| | - Hualin Cao
- Department of Pediatric Urology, Bayi Children's Hospital Affiliated to PLA Army General Hospital, Beijing, China
| | - Lifei Ma
- Department of Pediatric Urology, Bayi Children's Hospital Affiliated to PLA Army General Hospital, Beijing, China
| | - Xiaoguang Zhou
- Department of Pediatric Urology, Bayi Children's Hospital Affiliated to PLA Army General Hospital, Beijing, China
| | - Tian Tao
- Department of Pediatric Urology, Bayi Children's Hospital Affiliated to PLA Army General Hospital, Beijing, China
| | - Wei Cheng
- Department of Pediatric Urology, Bayi Children's Hospital Affiliated to PLA Army General Hospital, Beijing, China; Department of Pediatric Surgery, Beijing United Family Hospital, Beijing, China
| | - Zhichun Feng
- Department of Pediatrics, Bayi Children's Hospital Affiliated to PLA Army General Hospital, Beijing, China
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