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Fan S, Xiong S, Li Z, Yang K, Wang J, Han G, Li X, Chen S, Yuan C, Meng C, Dai X, Mu L, Li X, Zhou L. Pyeloplasty with the Kangduo Surgical Robot vs the da Vinci Si Robotic System: Preliminary Results. J Endourol 2022; 36:1538-1544. [PMID: 35864812 DOI: 10.1089/end.2022.0366] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Objective: To share our experience in robot-assisted pyeloplasty (RAP) with the Kangduo (KD) surgical robot vs the da Vinci Si (DV) robotic system (KD-RAP vs DV-RAP, respectively). Methods: From August 2019 to February 2021, 16 patients with ureteropelvic junction obstruction (UPJO) underwent KD-RAP and other 16 patients with UPJO accepted DV-RAP. All procedures were performed by the same surgeon. The perioperative results and follow-up data were prospectively collected and compared. Results: There was no conversion to open or laparoscopic surgery. The mean operation time was significantly longer in the KD-RAP group than the DV-RAP group (141 ± 28 minutes vs 118 ± 31 minutes, respectively, p = 0.04). The time per stitch was significantly longer in the KD-RAP group than the DV-RAP group (1.7 ± 0.5 minutes vs 1.4 ± 0.3 minutes, respectively, p = 0.05). No significant difference was noted in the estimated blood loss and the postoperative length of hospitalization. At a median follow-up of 19 (range 17-21) and 19.5 (range 14-33) months for the KD-RAP and DV-RAP groups, respectively, no difference was noted in the success rates between the KD-RAP and DV-RAP groups (93.75% and 100%, respectively; p = 0.31). Complications were comparable between the two groups (p = 0.54). One (6.3%) patient developed urinary infection, which responded well to oral antibiotics in KD-RAP group and 2 (12.5%) patients suffered from irritation symptoms of bladder, which improved after removal of Double-J stent in the DV-RAP group. Conclusions: The RAP with the use of the KD system was feasible, safe, and effective. The DV-RAP group showed advantage in the operation time and the time per stitch.
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Affiliation(s)
- Shubo Fan
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, Beijing, China
| | - Shengwei Xiong
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, Beijing, China
| | - Zhihua Li
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, Beijing, China
| | - Kunlin Yang
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, Beijing, China
| | - Jie Wang
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, Beijing, China
| | - Guanpeng Han
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, Beijing, China
| | - Xinfei Li
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, Beijing, China
| | - Silu Chen
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, Beijing, China
| | - Changwei Yuan
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, Beijing, China
| | - Chang Meng
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, Beijing, China
| | - Xiaofei Dai
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, Beijing, China
- Department of Urology, Civil Aviation General Hospital, Civil Aviation Medical College of Peking University, Beijing, China
| | - Li Mu
- Department of Operation Room, Peking University First Hospital, Beijing, China
| | - Xuesong Li
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, Beijing, China
| | - Liqun Zhou
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, Beijing, China
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Cooke I, Sadruddin S, Patil D, Tripathi S, Nabavizadeh R, Joshi S, Narayan V, Ogan K, Master VA. A Helpful Tool in the Renal Surgery Armamentarium: Dorsal Lumbotomy nephrectomy for Tumor in Patients with End-Stage Renal Disease. Urology 2021; 153:327-332. [PMID: 33774041 DOI: 10.1016/j.urology.2021.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Revised: 02/07/2021] [Accepted: 03/11/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To compare operative outcomes between the dorsal lumbotomy (DL) and laparoscopic nephrectomy (LN) approaches for patients with end stage renal disease (ESRD) undergoing nephrectomy. DL operative technique is also described. MATERIALS AND METHODS We performed a retrospective review of all patients undergoing DL nephrectomy at Emory University from 2008-2020. Cases were matched with control patients with ESRD who had undergone LN. Parameters evaluated included operative time, estimated blood loss, length of stay, postoperative narcotic requirements, and complication rates. Statistical analysis performed with SPSS. RESULTS 43 DL patients and 86 LN patients were assessed. DL had shorter total OR time (173min vs 198min; P = 0.001) and surgery time (101min vs 135min; P<0.001) compared to LN. There was a trend towards decreased mean length of stay among the DL group (2.65d vs 3.14d; P = 0.069) as well as daily narcotic requirement measured in oral morphine equivalents (54.8mg/day vs 73.6mg/day, P = 0.051). There were no differences in estimated blood loss, perioperative complication rates, ICU admissions, or 30-day readmissions. Limitations include retrospective design and small sample size. CONCLUSION Among patients with ESRD, DL was found to be safe and effective compared to LN, with shorter operative times, a trend towards decreased length of stay and post-operative narcotic requirements, and similar perioperative complication rates. DL should be considered as an approach for nephrectomy in this patient population.
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Affiliation(s)
- Ian Cooke
- Department of Urology, Emory University, Atlanta, GA
| | | | | | | | | | - Shreyas Joshi
- Department of Urology, Emory University, Atlanta, GA
| | | | - Kenneth Ogan
- Department of Urology, Emory University, Atlanta, GA
| | - Viraj A Master
- Department of Urology, Emory University, Atlanta, GA; Winship Cancer Institute, Emory University, Atlanta, GA.
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Roshan A, MacNeily AE. Dorsal lumbotomy for pediatric upper pole hemi-nephrectomy: Back (door) to the future? J Pediatr Urol 2020; 16:480.e1-480.e7. [PMID: 32536569 DOI: 10.1016/j.jpurol.2020.04.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 04/21/2020] [Accepted: 04/28/2020] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Upper pole heminephrectomy (UHN) is performed for two main indications in children: ectopic ureterocele and duplication anomalies with upper pole ectopy, both in the context of a poorly functioning upper pole moiety. Current popular techniques for conducting UHN include laparoscopic (LPN) and robot-assisted laparoscopic (RAPN). OBJECTIVE To evaluate outcomes following dorsal lumbotomy (DL), an open approach used historically for pyeloplasty and pyelolithotomy, and in which no clinical trials or exclusive case-series have been conducted for upper pole hemi-nephrectomy (UHN) in children. We ultimately aim to compare our outcomes following DL at our centre to that of published outcomes of minimally invasive approaches to UHN. STUDY DESIGN Institutional board review was obtained (H18-03716) for a retrospective review of 50 UHN performed in 49 consecutive pediatric patients using the DL approach by a single surgeon between 2001 and 2019. Clinical variables and indicators included age, sex, weight, skin-to-skin time, total operating room time, duration of hospital stay, post-operative complications, analgesic requirements, and post-operative ultrasound results. RESULTS Of 50 UHN performed, 23 had a presurgical diagnosis of ectopic ureter, and 27 ureterocele. Mean weight of patients was 12.61 kg, and the mean age at surgery was 24.55 months. Mean (range) for time between skin incision and closure was 88.5 (62-132) minutes, and the mean (range) total operating room time was 138.5 (70-180) minutes. There were neither intraoperative complications nor transfusions. The mean (range) post-operative opioid delivered was 0.73 (0.00-2.00) mg/kg/day. Mean (range) post-operative ibuprofen delivered was 5.41 (0.00-37.73) mg/kg/day. Median length of hospital stay was 2 days. No patient received post-operative prescriptions for narcotics at discharge. There were no wound complications. One patient had secondary atrophy of the lower pole. Secondary lower tract surgery, unrelated to surgical approach, was performed in five patients. Ten patients experienced a urinary tract infection at some point after surgery. CONCLUSION DL is safe, feasible, and produces operative outcomes and times comparable to that of laparoscopic and robotic techniques. These findings as well as operative costs should be considered when selecting a surgical technique for UHN.
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Affiliation(s)
- Aishwarya Roshan
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - A E MacNeily
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada; Department of Urologic Sciences, University of British Columbia, BC Children's Hospital, Vancouver, BC, Canada.
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Sharifiaghdas F, Mirzaei M, Daneshpajooh A, Abbaszadeh S. Minimally invasive open dismembered pyeloplasty technique: Miniature incision, muscle-splitting dissection, and nopelvis reduction in children. Asian J Urol 2018; 6:290-293. [PMID: 31297321 PMCID: PMC6595094 DOI: 10.1016/j.ajur.2018.08.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2017] [Revised: 04/18/2017] [Accepted: 09/27/2017] [Indexed: 12/01/2022] Open
Abstract
Objective To report the outcomes and complications of open dismembered Anderson-Hynes pyeloplasty with miniature incision in treating children's ureteropelvic junction obstruction. Methods Between March 2007 and April 2011, 109 children with a mean age of 2 years and 8 months old with ureteropelvic junction obstruction underwent open dismembered pyeloplasty. Clinical manifestations, radiographic assessments, incision size, surgery time, hospital stay, and complication rate were recorded. All patients had a documented ureteropelvic junction obstruction (having T1/2 more than 20 min in diethylenetriaminepentaacetic acid [DTPA] scan) with symptomatic stenosis or decreased kidney function (differential function <40%). Pyeloplasty was done by a retroperitoneal flank approach with miniature incision without pelvis reduction. One surgeon did all the surgeries. Success rate and complications were assessed in a 3-year follow-up. Results Mean surgery time was 52 min (47–60 min). Incision size was 18–28 mm. Mean hospital stay was 3 days (2–8 days). The surgery was successful in 98.2% of patients with a mean follow-up time of 36 months (success was defined as disappearance of symptoms, if present, with improved ultrasound imaging results or Reno graphic parameters). The complication rate was 7.33%, including urinary leakage, double-J urethral stent dislocation and infection. Conclusion Open dismembered pyeloplasty is a safe, technically feasible and effective therapy in treatment of children's ureteropelvic junction obstruction. It takes a short time to do, requires a small incision and has few complications and a short recovery period.
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Affiliation(s)
- Farzaneh Sharifiaghdas
- Urology-Nephrology Research Center, Labbafinejad Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mahboubeh Mirzaei
- Department of Urology, Shahid Bahonar Hospital, Kerman University of Medical Sciences, Kerman, Iran
| | - Azar Daneshpajooh
- Department of Urology, Shahid Bahonar Hospital, Kerman University of Medical Sciences, Kerman, Iran
| | - Shahin Abbaszadeh
- Urology-Nephrology Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
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Salö M, Sjöberg Altemani T, Anderberg M. Pyeloplasty in children: perioperative results and long-term outcomes of robotic-assisted laparoscopic surgery compared to open surgery. Pediatr Surg Int 2016; 32:599-607. [PMID: 26833312 DOI: 10.1007/s00383-016-3869-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/19/2016] [Indexed: 12/29/2022]
Abstract
BACKGROUND A few studies have compared robotic-assisted laparoscopic pyeloplasty (RALP) with open pyeloplasty (OP) in children, but no previous study includes a long-term follow-up of renal function and hydronephrosis in combination with a thorough prospective follow-up of the RALP patients of at least 2 years. OBJECTIVE To analyze perioperative results and long-term outcome of children with obstruction of the ureteropelvic junction, operated on with RALP compared to OP. PATIENTS AND METHODS Children ≤15 years operated on with RALP or OP from 2000 through 2013 were reviewed. Patient demographics, perioperative data, postoperative complications, and long-term outcome were evaluated. The outcome was based on pre- and postoperative examination of renal function, hydronephrosis and flank pain. RESULTS 129 pyeloplasties (84 OP, 39 RALP, 6 reoperations) on 123 patients were included. RALP had significantly longer operative time and shorter postoperative hospital stay, compared to OP. No difference was found in postoperative need of morphine or complication rates. Mean follow-up for RALP with ultrasound was 29 and 25 months with renal scan, compared to 34 and 28 months, respectively, for OP. The success rate for flank pain was 96 and 94 %, for hydronephrosis 93 and 95 %, and renal function 94 and 92 %, for RALP and OP, respectively. CONCLUSIONS RALP is a safe method, with advantages compared to OP, and with the same success rate. This study supports the use of RALP in children.
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Affiliation(s)
- Martin Salö
- Department of Pediatric Surgery, Skåne University Hospital, Lasarettsgatan 48, 221 85, Lund, Sweden. .,Department of Clinical Sciences, Pediatrics, Lund University, Lund, Sweden.
| | - Tania Sjöberg Altemani
- Department of Pediatric Surgery, Skåne University Hospital, Lasarettsgatan 48, 221 85, Lund, Sweden
| | - Magnus Anderberg
- Department of Pediatric Surgery, Skåne University Hospital, Lasarettsgatan 48, 221 85, Lund, Sweden.,Department of Clinical Sciences, Pediatrics, Lund University, Lund, Sweden
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6
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Tennyson LE, Lyon TD, Farber NJ, Correa AF, Hrebinko RL. Dorsal Lumbotomy Incision for Partial Nephrectomy in Patients With Small Posterior Renal Masses. Urology 2016; 87:120-4. [DOI: 10.1016/j.urology.2015.09.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2015] [Revised: 09/15/2015] [Accepted: 09/21/2015] [Indexed: 01/20/2023]
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7
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Mattioli G, Avanzini S, Pio L, Costanzo S, Faticato MG, Montobbio G, Disma N, Buffa P. Transperitoneal Laparoscopic Approach to the Perinephric Area in Children: Technical Report and Lessons Learned. J Laparoendosc Adv Surg Tech A 2015; 25:841-6. [DOI: 10.1089/lap.2014.0643] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Girolamo Mattioli
- Pediatric Surgery Department, Giannina Gaslini Institute, Genoa, Italy
- DINOGMI, University of Genoa, Genoa, Italy
| | - Stefano Avanzini
- Pediatric Surgery Department, Giannina Gaslini Institute, Genoa, Italy
| | - Luca Pio
- Pediatric Surgery Department, Giannina Gaslini Institute, Genoa, Italy
- DINOGMI, University of Genoa, Genoa, Italy
| | - Sara Costanzo
- Pediatric Surgery Department, Giannina Gaslini Institute, Genoa, Italy
- DINOGMI, University of Genoa, Genoa, Italy
| | - Maria Grazia Faticato
- Pediatric Surgery Department, Giannina Gaslini Institute, Genoa, Italy
- DINOGMI, University of Genoa, Genoa, Italy
| | - Giovanni Montobbio
- Intensive Care Unit, Giannina Gaslini Institute, Genoa, Italy
- Anesthesiology Department, Giannina Gaslini Institute, Genoa, Italy
| | - Nicola Disma
- Intensive Care Unit, Giannina Gaslini Institute, Genoa, Italy
- Anesthesiology Department, Giannina Gaslini Institute, Genoa, Italy
| | - Piero Buffa
- Pediatric Surgery Department, Giannina Gaslini Institute, Genoa, Italy
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8
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Bansal D, Cost NG, DeFoor WR, Reddy PP, Minevich EA, Vanderbrink BA, Alam S, Sheldon CA, Noh PH. Infant robotic pyeloplasty: comparison with an open cohort. J Pediatr Urol 2014; 10:380-5. [PMID: 24268880 DOI: 10.1016/j.jpurol.2013.10.016] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2013] [Accepted: 10/23/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To present our experience with infant pyeloplasty, comparing outcomes between robotic-assisted laparoscopic pyeloplasty (RALP) and open pyeloplasty (OP). MATERIALS AND METHODS A retrospective review was performed of all children <1 year of age who underwent unilateral dismembered pyeloplasty at a single pediatric institution since January 2007. Patients with standard laparoscopic pyeloplasty were excluded. Patient demographics, intraoperative details, narcotic usage, and complications were reviewed. RESULTS A total of 70 infants (51 boys and 19 girls) were identified, with nine RALP and 61 OP performed. Median age was 9.2 months (range, 3.7-11.9 months) for RALP and 4.1 months (range, 1.0-11.6 months) for OP (p = 0.005). Median weight was 8 kg (range, 5.8-10.9 kg) for RALP and 7 kg (range, 4-14 kg) for OP (p = 0.163). Median operative time was 115 min (range, 95-205 min) for RALP and 166 min (range, 79-300 min) for OP (p = 0.028). Median hospital stay was 1 day (range, 1-2 days) for RALP and 3 days (range, 1-7 days) for OP (p < 0.001). Median postoperative narcotic use of morphine equivalent was <0.01 mg/kg/day (range, 0-0.1 mg/kg/day) for RALP and 0.05 mg/kg/day (range, 0-2.2 mg/kg/day) for OP (p < 0.001). Median follow-up was 10 months (range, 7.2-17.8 months) for RALP and 43.6 months (3.4-73.8 months) for OP (p < 0.001). The success rate was 100% for RALP and 98% for OP. CONCLUSIONS Infant RALP was observed to be feasible and efficacious with shorter operative time, hospital stay, and narcotic utilization than OP.
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Affiliation(s)
- D Bansal
- Division of Pediatric Urology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, ML 5037, Cincinnati, OH 45229, USA
| | - N G Cost
- Division of Pediatric Urology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, ML 5037, Cincinnati, OH 45229, USA
| | - W R DeFoor
- Division of Pediatric Urology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, ML 5037, Cincinnati, OH 45229, USA
| | - P P Reddy
- Division of Pediatric Urology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, ML 5037, Cincinnati, OH 45229, USA
| | - E A Minevich
- Division of Pediatric Urology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, ML 5037, Cincinnati, OH 45229, USA
| | - B A Vanderbrink
- Division of Pediatric Urology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, ML 5037, Cincinnati, OH 45229, USA
| | - S Alam
- Division of Pediatric Urology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, ML 5037, Cincinnati, OH 45229, USA
| | - C A Sheldon
- Division of Pediatric Urology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, ML 5037, Cincinnati, OH 45229, USA
| | - P H Noh
- Division of Pediatric Urology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, ML 5037, Cincinnati, OH 45229, USA.
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9
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Bansal P, Gupta A, Mongha R, Narayan S, Kundu AK, Chakraborty SC, Das RK, Bera MK. Laparoscopic versus open pyeloplasty: Comparison of two surgical approaches -- a single centre experience of three years. J Minim Access Surg 2013; 4:76-9. [PMID: 19547693 PMCID: PMC2699080 DOI: 10.4103/0972-9941.43091] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2008] [Accepted: 08/12/2008] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND: Ureteropelvic junction obstruction (UPJO) causes hydronephrosis and progressive renal impairment may ensue if left uncorrected. Open pyeloplasty remains the standard against which new technique must be compared. We compared laparoscopic (LP) and open pyeloplasty (OP) in a randomized prospective trial. MATERIALS AND METHODS: A prospective randomized study was done from January 2004 to January 2007 in which a total of 28 laparoscopic and 34 open pyeloplasty were done. All laparoscopic pyeloplasties were performed transperitoneally. Standard open Anderson Hynes pyeloplasty, spiral flap or VY plasty was done depending on anatomic consideration. Patients were followed with DTPA scan at three months and IVP at six months. Perioperative parameters including operative time, analgesic use, hospital stay, and complication and success rates were compared. RESULTS: Mean total operative time with stent placement in LP group was 244.2 min (188-300 min) compared to 122 min (100-140 min) in OP group. Compared to OP group, the post operative diclofenac requirement was significantly less in LP group (mean 107.14 mg) and OP group required mean of (682.35 mg). The duration of analgesic requirement was also significantly less in LP group. The postoperative hospital stay in LP was mean 3.14 Days (2-7 days) significantly less than the open group mean of 8.29 days (7-11 days). CONCLUSION: LP has a minimal level of morbidity and short hospital stay compared to open approach. Although, laparoscopic pyeloplasty has the disadvantages of longer operative time and requires significant skill of intracorporeal knotting but it is here to stay and represents an emerging standard of care.
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Affiliation(s)
- Punit Bansal
- Department of Urology, Institute of Post Graduate Medical Education and Research, Kolkata, India
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10
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Kim J, Park S, Hwang H, Kim JW, Cheon SH, Park S, Kim KS. Comparison of Surgical Outcomes between Dismembered Pyeloplasty with or without Ureteral Stenting in Children with Ureteropelvic Junction Obstruction. Korean J Urol 2012; 53:564-8. [PMID: 22950002 PMCID: PMC3427842 DOI: 10.4111/kju.2012.53.8.564] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2012] [Accepted: 07/09/2012] [Indexed: 11/18/2022] Open
Abstract
PURPOSE To evaluate the impact of temporary internal ureteral stents on the surgical outcomes of dismembered pyeloplasty in children. MATERIALS AND METHODS The medical records of 70 children (76 renal units) who underwent dismembered pyeloplasty for ureteropelvic junction (UPJ) obstruction at at Asan Medical Center between January 2005 and December 2010 were retrospectively reviewed. We classified the renal units into the stented group (22 renal units) and the nonstented group (54 renal units). Fifty-four of 70 patients were male and their mean age was 2.2±3.8 years old. The mean follow-up period was 29.6±16.8 months. RESULTS Sixty-four children had unilateral UPJ obstruction. The mean stent duration was 31.9 days. As shown by evaluation of radiologic images, there were no significant differences between the stented group and the nonstented group during the follow-up period (p>0.05). The mean preoperative and postoperative anteroposterior pelvic diameters (APPDs) of the nonstented group were 31.3 mm and 15.1 mm, respectively (p<0.001). The preoperative and postoperative grades of hydronephrosis were 3.9 and 2.9, respectively (p=0.037). The mean preoperative and postoperative APPDs of the stented group were 36.4 mm and 15.6 mm, respectively (p<0.001). The preoperative and postoperative grades of hydronephrosis were 4 and 3.1, respectively (p<0.001). Repeat obstruction was shown in 4 subjects as a postoperative complication (5.7%). Two children from each group had recurrent UPJ obstruction, with percentages of 3.7% and 9%, respectively (p=0.575). CONCLUSIONS In a comparison of nonstented and stented groups during pediatric dismembered pyeloplasty for UPJ obstruction, no significant differences were found in the resolution of hydronephrosis or overall postoperative complications.
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Affiliation(s)
- June Kim
- Department of Urology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
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11
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Mei H, Pu J, Yang C, Zhang H, Zheng L, Tong Q. Laparoscopic Versus Open Pyeloplasty for Ureteropelvic Junction Obstruction in Children: A Systematic Review and Meta-Analysis. J Endourol 2011; 25:727-36. [PMID: 21476861 DOI: 10.1089/end.2010.0544] [Citation(s) in RCA: 99] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Affiliation(s)
- Hong Mei
- Department of Pediatric Surgery, Union Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jiarui Pu
- Department of Pediatric Surgery, Union Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Chunlei Yang
- Department of Pediatric Surgery, Union Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Huanyu Zhang
- Department of Pediatric Surgery, Union Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Liduan Zheng
- Department of Pathology, Union Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Qiangsong Tong
- Department of Pediatric Surgery, Union Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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12
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Bansal P, Gupta A, Mongha R, Narayan S, Das RK, Bera M, Chakraborty SC, Kundu AK. Laparoscopic versus open pyeloplasty: comparison of two surgical approaches- a single centre experience of three years. Indian J Surg 2011; 73:264-7. [PMID: 22851839 DOI: 10.1007/s12262-011-0237-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2008] [Accepted: 03/16/2011] [Indexed: 11/25/2022] Open
Abstract
UPJO causes hydronephrosis and progressive renal impairment may ensue if left uncorrected. Open pyeloplasty remains the standard against which new technique must be compared. We analyzed the comparison of Laparoscopic and open pyeloplasty in a randomized prospective trial. A prospective randomized study was done from January 2004 to January 2007 in which a total of 28 Laparoscopic and 34 open pyeloplasty were done. All laparoscopic pyeloplasties were performed transperitoneally. Standard open Anderson Hynes pyeloplasty, spiral flap or VY plasty was done depending on anatomic consideration. Patients were followed with DTPA scan at 3 months and IVP at 6 months. Perioperative parameters including operative time, analgesic use, hospital stay, and complication and success rates were compared. Mean total operative time with stent placement in LP group was 244.2 min (188-300 min) compared to 122 min (100-140 min) in open group. Compared to open pyeloplasty the post operative diclofenac requirement was significantly less in LP group (mean107.14 mg) and open group required mean of (682.35 mg) The duration of analgesic requirement was also significantly less in LP group. The post operative hospital stay in LP was mean 8.29 days (7-11) and was significantly less than open group (mean 3.14 Days (2-7 days). Open pyeloplasty has been the gold standard for UPJO repair and achieves success rates exceeding 90%. Laparoscopic pyeloplasty provides a minimally invasive alternative to repair UPJO and has developed world wide as the first minimally option to match success rate of open pyeloplasty. Its potential advantages including less post op pain, shorter hospital stay an improved cosmesis has been proved in some comparative series. The only disadvantage seems to be longer operative time. LP has a minimal level of morbidity and short hospital stay compared to open approach Although Laparoscopic pyeloplasty has the disadvantages of longer operative time and requires significant skill of intracorporeal knotting but it is here to stay and represents an emerging standard of care.
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Affiliation(s)
- Punit Bansal
- IPGMER &SSKM HOSPITAL, 329, Doctors Hostel, 242, AJC Bose Road, Kolkata, 700020 India
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Singh O, Gupta SS, Hastir A, Arvind NK. Laparoscopic Dismembered Pyeloplasty for Ureteropelvic Junction Obstruction: Experience with 142 Cases in a High-Volume Center. J Endourol 2010; 24:1431-4. [DOI: 10.1089/end.2010.0002] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Onkar Singh
- Department of Urology, Bhopal Memorial Hospital and Research Centre, Bhopal, India
| | - Shilpi Singh Gupta
- Department of Urology, Bhopal Memorial Hospital and Research Centre, Bhopal, India
| | - Ankur Hastir
- Department of Surgery, MGM Medical College and Hospital, Navi Mumbai, Kamothe, India
| | - Nand Kishore Arvind
- Department of Urology, Bhopal Memorial Hospital and Research Centre, Bhopal, India
- Department of Urology, BGS Apollo Hospital, Kuvempu Nagar, Mysoor, Karnataka, India
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Short Stay Pyeloplasty With Transverse Dorsal Lumbotomy Incision: Our 10-Year Experience. Urology 2009; 74:1309-12. [DOI: 10.1016/j.urology.2009.06.090] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2009] [Revised: 06/11/2009] [Accepted: 06/16/2009] [Indexed: 11/22/2022]
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Chuanyu S, Guowei X, Ke X, Qiang D, Yuanfang Z. Retroperitoneal Laparoscopic Dismembered Anderson-Hynes Pyeloplasty in Treatment of Ureteropelvic Junction Obstruction (Report of 150 cases). Urology 2009; 74:1036-40. [DOI: 10.1016/j.urology.2009.04.083] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2008] [Revised: 04/04/2009] [Accepted: 04/14/2009] [Indexed: 10/20/2022]
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16
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Wagner S, Greco F, Inferrera A, Hoda MR, Kawan F, Hamza A, Fornara P. Laparoscopic dismembered pyeloplasty: technique and results in 105 patients. World J Urol 2009; 28:615-8. [DOI: 10.1007/s00345-009-0483-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2009] [Accepted: 10/05/2009] [Indexed: 11/29/2022] Open
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Srivastava A, Muruganandham K, Gupta P, Dubey D, Kapoor R, Kumar A, Gupta A, Sharma RK. The optimum approach for pre-transplant bilateral nephrectomy in small kidneys: dorsal lumbotomy vs laparoscopy. BJU Int 2009; 104:998-1001. [DOI: 10.1111/j.1464-410x.2009.08485.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Savoie PH, Lechevallier E, Crochet P, Saïdi A, Breton X, Delaporte V, Coulange C. [Retrograde endopyelotomy using Holmium-Yag laser for uretero-pelvic junction obstruction]. Prog Urol 2008; 19:27-32. [PMID: 19135639 DOI: 10.1016/j.purol.2008.07.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2007] [Accepted: 07/02/2008] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To evaluate our results of retrograde laser endopyelotomy for uretero-pelvic junction obstruction. MATERIAL AND METHODS Retrospective study of 27 consecutive retrograde laser endopyelotomies performed on 24 patients over a six years period (June 1999 to July 2005). Sixteen stenoses were primary. The level of obstruction was severe in 13 patients and moderate in 14 patients. A polar pedicle was diagnosed by pre-operative CT-angiography in seven cases. Balloon dilatation was performed in 17 procedures. A double J ureteral stent remained in place for six weeks mean. We evaluated results by a clinical examination and an excretory urography (at 1 and 6 months then annually). Mean follow-up was 35+/-22.7 months. RESULTS Mean operating time and mean length of hospital stay were 49.8+/-17.9min and four days (range: 2-10 days). Two cases of pyelonephritis were observed. The overall success was 70%. In the eight unresolved cases, the failure appeared at 2.7+/-1 month mean. Success criteria were moderate level of obstruction and primary junction. Here, patients so selected have 100% of success. CONCLUSION Study confirmed retrograde laser endopyelotomy was safety with a short length of hospital stay. This minimally invasive procedure should be reserved to primary moderate stenoses without polar pedicle.
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Affiliation(s)
- P-H Savoie
- Service d'urologie et de transplantation rénale, hôpital La Conception, 149, boulevard Baille, 13006 Marseille, France.
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Abstract
The term ureteropelvic junction (UPJ) obstruction covers different morbid entities, and the old aphorism, "A UPJ is not a UPJ" remains true. Hydronephrosis is readily seen on antenatal ultrasonography but does not necessarily imply obstruction. Although most cases will resolve spontaneously, the probability of a significant pathology is related to the degree of pyelectasis, as seen on the third trimester study. Criteria of obstruction are difficult to define with precision, but two that are well-accepted are size of the renal pelvis (> 15 mm) and relative renal function, as determined by adequate isotopic studies. A new therapeutic standard has been established, and minimally invasive surgery has finally dethroned its open rival. Possibly facilitated by robotic assistance, laparoscopic dismembered pyeloplasty is the present gold standard, albeit endopyelotomy remains the least invasive with similar results in carefully selected patients.
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Affiliation(s)
- Paul J Van Cangh
- Department of Urology, Univerité Catholique de Louvain, Cliniques Universitaires St Luc, 10 Avenue Hippocrate, 1200 Brussels, Belgium.
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