1
|
Planchamp T, Bento L, Mouttalib S, Belbahri I, Coustets B, Aissa DA, Abbo O. Robotic pyeloplasty learning curve for a pediatric surgeon without previous laparoscopic pyeloplasty experience. J Robot Surg 2023; 17:2955-2962. [PMID: 37864128 DOI: 10.1007/s11701-023-01737-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Accepted: 09/26/2023] [Indexed: 10/22/2023]
Abstract
Robotic pyeloplasty has become a technique of choice for pyelo-ureteral junction syndrome treatment in children. Less invasive than open surgery, robotic pyeloplasty also has a lower learning curve than laparoscopic pyeloplasty. This is how a new generation of surgeons without previous laparoscopic pyeloplasty experience has begun training in robotics. To assess the robotic assisted pyeloplasty learning curve for a pediatric surgeon only trained in open pyeloplasty, and to investigate if that mode of practice is safe and effective. Data were collected from all children operated on for pyelo-ureteral junction syndrome by the same surgeon in our center between 2015 and 2021. Cases were divided into 4 groups of 14 consecutive procedures to analyze the learning curve. Fifty-six patients were operated on, with a median (IQR) age, weight, and hospital stay of 9 years and 1 month old (3.5), 29 kg (17.3), and 3 days (2), respectively. The mean ± SD operative times were 146.5 ± 39.3, 123.2 ± 48.1, 103.1 ± 29.5, and 141.7 ± 25.0 min, with a unique significant difference between groups 1 and 3 (p = 0.007**). Only two intraoperative and nine postoperative complications were observed. The surgery was successful in 98% cases. Our study shows that a significant improvement in surgical time could be achieved in the first 30 cases, safely and efficiently even without previous laparoscopic pyeloplasty experience.Level of evidence: III.
Collapse
Affiliation(s)
- Thibault Planchamp
- Department of Pediatric Surgery, H, pital Des Enfants, CHU Toulouse, 330, Avenue de Grande Bretagne - TSA 70034, 31059, Toulouse, France.
| | - Lucas Bento
- Department of Urology, Hôpital Rangueil, CHU Toulouse, Toulouse, France
| | - Sofia Mouttalib
- Department of Pediatric Surgery, H, pital Des Enfants, CHU Toulouse, 330, Avenue de Grande Bretagne - TSA 70034, 31059, Toulouse, France
| | - Ichrak Belbahri
- Department of Pediatric Surgery, H, pital Des Enfants, CHU Toulouse, 330, Avenue de Grande Bretagne - TSA 70034, 31059, Toulouse, France
| | - Bernard Coustets
- Department of Anesthesia, Hôpital des Enfants-CHU Toulouse, Toulouse, France
| | - Dalinda Ait Aissa
- Department of Anesthesia, Hôpital des Enfants-CHU Toulouse, Toulouse, France
| | - Olivier Abbo
- Department of Pediatric Surgery, H, pital Des Enfants, CHU Toulouse, 330, Avenue de Grande Bretagne - TSA 70034, 31059, Toulouse, France
| |
Collapse
|
2
|
Outcomes of robot-assisted transperitoneal pyeloplasty: Case series. JOURNAL OF SURGERY AND MEDICINE 2019. [DOI: 10.28982/josam.638664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
3
|
Chammas MF, Mitre AI, Arap MA, Hubert N, Hubert J. Learning robotic pyeloplasty without simulators: an assessment of the learning curve in the early robotic era. Clinics (Sao Paulo) 2019; 74:e777. [PMID: 31271586 PMCID: PMC6585868 DOI: 10.6061/clinics/2019/e777] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Accepted: 02/19/2019] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To analyze our experience and learning curve for robotic pyeloplasty during this robotic procedure. METHODS Ninety-nine patients underwent 100 consecutive procedures. Cases were divided into 4 groups of 25 consecutive procedures to analyze the learning curve. RESULTS The median anastomosis times were 50.0, 36.8, 34.2 and 29.0 minutes (p=0.137) in the sequential groups, respectively. The median operative times were 144.6, 119.2, 114.5 and 94.6 minutes, with a significant difference between groups 1 and 2 (p=0.015), 1 and 3 (p=0.002), 1 and 4 (p<0.001) and 2 and 4 (p=0.022). The mean hospital stay was 7.08, 4.76, 4.88 and 4.20 days, with a difference between groups 1 and 2 (p<0.001), 1 and 3 (p<0.001) and 1 and 4 (p<0.001). Clinical and radiological improvements were observed in 98.9% of patients. One patient presented with recurrent obstruction. CONCLUSIONS Our results demonstrate a high success rate with low complication rates. A significant decrease in hospital stay and surgical time was evident after 25 cases.
Collapse
Affiliation(s)
- Mario F Chammas
- Divisao de Urologia, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, BR
- Corresponding author. E-mails: /
| | - Anuar I Mitre
- Divisao de Urologia, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, BR
- Divisao de Urologia, Hospital Sirio-Libanes, Sao Paulo, SP, BR
| | - Marco A Arap
- Divisao de Urologia, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, BR
- Divisao de Urologia, Hospital Sirio-Libanes, Sao Paulo, SP, BR
| | - Nicholas Hubert
- Division of Urology, Centre Hospitalier Universitaire de Nancy, Nancy, France
| | - Jacques Hubert
- Division of Urology, Centre Hospitalier Universitaire de Nancy, Nancy, France
| |
Collapse
|
4
|
Rühle A, Arbelaez E, Mattei A, Danuser H. The Watertightness of the Anastomosis After Laparoscopic or Robot-Assisted Pyeloplasty: Is a Drainage Necessary? J Endourol 2017; 31:295-299. [DOI: 10.1089/end.2016.0655] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Affiliation(s)
- Annika Rühle
- Klinik für Urologie, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Emilio Arbelaez
- Klinik für Urologie, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Agostino Mattei
- Klinik für Urologie, Luzerner Kantonsspital, Lucerne, Switzerland
| | | |
Collapse
|
5
|
Ener K, Altınova S, Canda AE, Özcan MF, Asil E, Ürer E, Atmaca AF, Akbulut Z. Outcomes of robot-assisted laparoscopic transperitoneal pyeloplasty procedures: a series of 18 patients. Turk J Urol 2015; 40:193-8. [PMID: 26328177 DOI: 10.5152/tud.2014.33898] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2014] [Accepted: 09/24/2014] [Indexed: 12/29/2022]
Abstract
OBJECTIVE We evaluated outcomes of our robot-assisted laparoscopic transperitoneal pyeloplasty (RALP) procedures. MATERIAL AND METHODS Between July 2011 and March 2014, 18 RALP procedures were performed at our instutition. Ureteropelvic junction obstruction (UPJO) diagnosis was made based on clinical presentation and intravenous urography. All patients underwent basal and diuretic isotopic renography to evaluate the degree of obstruction and impaired renal function. Anderson-Hynes dismembered pyeloplasty technique was used with a transperitoneal approach by using the da Vinci-S 4-arm surgical robot. Outcomes were assessed retrospectively. RESULTS Mean patient age was 31.3±11.7 (13-62) years. Male: female ratio was 9: 9. All procedures were primary surgeries. Of 18 patients, 10 (55.5%) had a crossing vessel and 8 (44.5%) had intrinsic obstruction. Mean operative time was 150.4±17.2 (115-185) minutes. Mean anastomosis time was 21.4±5.5 (10-33) minutes. Mean blood loss during the operation was 33.6±17.3 (10-60) cc. Mean hospital stay was 2.6±1.0 (1-6) days. No conversion to open surgery was required. No intraoperative and perioperative (0-30 days) complication occurred. Readmission rate during perioperative period was 0%. Median follow-up was 16.6±10.3 (3-35) months. Postoperative intravenous urography and renography showed improved results in all cases. CONCLUSION Due to our experience, RALP is a safe and feasible minimally invasive approach in patients with UPJO with excellent surgical and functional outcomes.
Collapse
Affiliation(s)
- Kemal Ener
- Department of Urology, Ankara Atatürk Training and Research Hospital, Ankara, Turkey
| | - Serkan Altınova
- Department of Urology, Ankara Atatürk Training and Research Hospital, Ankara, Turkey
| | - Abdullah Erdem Canda
- Department of Urology, Yıldırım Beyazıt University Faculty of Medicine, Ankara Atatürk Training and Research Hospital, Ankara, Turkey
| | - Muhammet Fuat Özcan
- Department of Urology, Ankara Atatürk Training and Research Hospital, Ankara, Turkey
| | - Erem Asil
- Department of Urology, Ankara Atatürk Training and Research Hospital, Ankara, Turkey
| | - Emre Ürer
- Department of Urology, Ankara Atatürk Training and Research Hospital, Ankara, Turkey
| | - Ali Fuat Atmaca
- Department of Urology, Yıldırım Beyazıt University Faculty of Medicine, Ankara Atatürk Training and Research Hospital, Ankara, Turkey
| | - Ziya Akbulut
- Department of Urology, Yıldırım Beyazıt University Faculty of Medicine, Ankara Atatürk Training and Research Hospital, Ankara, Turkey
| |
Collapse
|
6
|
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
|
7
|
Abstract
BACKGROUND AND OBJECTIVES We aimed to assess the feasibility and outcomes of complex ureteropelvic junction obstruction cases submitted to robotic-assisted laparoscopic pyeloplasty. METHODS The records of 131 consecutive patients who underwent robotic-assisted laparoscopic pyeloplasty were reviewed. Of this initial population of cases, 17 were considered complex, consisting of either atypical anatomy (horseshoe kidneys in 3 patients) or previous ureteropelvic junction obstruction management (14 patients). The patients were divided into 2 groups: primary pyeloplasty (group 1) and complex cases (group 2). RESULTS The mean operative time was 117.3 ± 33.5 minutes in group 1 and 153.5 ± 31.1 minutes in group 2 (P = .002). The median hospital stay was 5.19 ± 1.66 days in group 1 and 5.90 ± 2.33 days in group 2 (P = .326). The surgical findings included 53 crossing vessels in group 1 and 5 in group 2. One patient in group 1 required conversion to open surgery because of technical difficulties. One patient in group 2, with a history of hemorrhagic rectocolitis, presented with peritonitis postoperatively due to a small colonic injury. A secondary procedure was performed after the patient had an uneventful recovery. At 3 months, significant improvement (clinical and radiologic) was present in 93% of cases in group 1 and 88.2% in group 2. At 1 year, all patients in group 2 showed satisfactory results. At a late follow-up visit, 1 patient in group 1 presented with a recurrent obstruction. CONCLUSIONS Robotic pyeloplasty appear to be feasible and effective, showing a consistent success rate even in complex situations. Particular care should be observed during the colon dissection in patients with previous colonic pathology.
Collapse
Affiliation(s)
- Mario F Chammas
- Division of Urology, University of São Paulo School of Medicine, São Paulo, Brazil.
| | - Anuar I Mitre
- Division of Urology, University of São Paulo School of Medicine, São Paulo, Brazil
| | - Nicolas Hubert
- Department of Urology, University Henri Poincare/CHU Nancy, Vandoeuvre-lèsNancy, France
| | - Christophe Egrot
- Department of Urology, University Henri Poincare/CHU Nancy, Vandoeuvre-lèsNancy, France
| | - Jacques Hubert
- Department of Urology, University Henri Poincare/CHU Nancy, Vandoeuvre-lèsNancy, France
| |
Collapse
|
8
|
Danuser H, Germann C, Pelzer N, Rühle A, Stucki P, Mattei A. One- vs 4-week stent placement after laparoscopic and robot-assisted pyeloplasty: results of a prospective randomised single-centre study. BJU Int 2014; 113:931-5. [DOI: 10.1111/bju.12652] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- H. Danuser
- Klinik für Urologie; Luzerner Kantonsspital; Lucerne Switzerland
| | - C. Germann
- Klinik für Urologie; Luzerner Kantonsspital; Lucerne Switzerland
| | - N. Pelzer
- Klinik für Urologie; Luzerner Kantonsspital; Lucerne Switzerland
| | - A. Rühle
- Klinik für Urologie; Luzerner Kantonsspital; Lucerne Switzerland
| | - P. Stucki
- Klinik für Urologie; Luzerner Kantonsspital; Lucerne Switzerland
| | - A. Mattei
- Klinik für Urologie; Luzerner Kantonsspital; Lucerne Switzerland
| |
Collapse
|
9
|
Bedaiwy MA, Franjoine SE, Ali MK. Laparoendoscopic single-site (LESS) surgery in gynecology: Current status and future directions. MIDDLE EAST FERTILITY SOCIETY JOURNAL 2013. [DOI: 10.1016/j.mefs.2012.11.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
|
10
|
Boylu U, Basatac C, Turan T, Onol FF, Gumus E. Comparison of Surgical and Functional Outcomes of Minimally Invasive and Open Pyeloplasty. J Laparoendosc Adv Surg Tech A 2012; 22:968-71. [DOI: 10.1089/lap.2012.0142] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Ugur Boylu
- Department of Urology, Umraniye Teaching Hospital, Istanbul, Turkey
| | - Cem Basatac
- Department of Urology, Umraniye Teaching Hospital, Istanbul, Turkey
| | - Turgay Turan
- Department of Urology, Umraniye Teaching Hospital, Istanbul, Turkey
| | | | - Eyup Gumus
- Department of Urology, Umraniye Teaching Hospital, Istanbul, Turkey
| |
Collapse
|
11
|
Bird VG, Leveillee RJ, Eldefrawy A, Bracho J, Aziz MS. Comparison of Robot-assisted Versus Conventional Laparoscopic Transperitoneal Pyeloplasty for Patients With Ureteropelvic Junction Obstruction: A Single-center Study. Urology 2011; 77:730-4. [DOI: 10.1016/j.urology.2010.07.540] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2010] [Revised: 07/02/2010] [Accepted: 07/24/2010] [Indexed: 11/29/2022]
|
12
|
Giri SK, Murphy D, Costello AJ, Moon DA. Laparoscopic Pyeloplasty Outcomes of Elderly Patients. J Endourol 2011; 25:251-6. [DOI: 10.1089/end.2010.0384] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Subhasis K. Giri
- The Royal Melbourne Hospital, Grattan Street, Parkville, Victoria, Australia
| | - Declan Murphy
- The Royal Melbourne Hospital, Grattan Street, Parkville, Victoria, Australia
| | - Anthony J. Costello
- The Royal Melbourne Hospital, Grattan Street, Parkville, Victoria, Australia
| | - Daniel A. Moon
- The Royal Melbourne Hospital, Grattan Street, Parkville, Victoria, Australia
| |
Collapse
|
13
|
Abuanz S, Gamé X, Roche JB, Guillotreau J, Mouzin M, Sallusto F, Chaabane W, Malavaud B, Rischmann P. Laparoscopic Pyeloplasty: Comparison Between Retroperitoneoscopic and Transperitoneal Approach. Urology 2010; 76:877-81. [DOI: 10.1016/j.urology.2009.11.062] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2009] [Revised: 10/20/2009] [Accepted: 11/24/2009] [Indexed: 10/19/2022]
|
14
|
Yong D, Albala DM. Endopyelotomy in the age of laparoscopic and robotic-assisted pyeloplasty. Curr Urol Rep 2010; 11:74-9. [PMID: 20425093 DOI: 10.1007/s11934-010-0090-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Ureteropelvic junction obstructixon (UPJO) management has undergone significant changes in the past few years. The aim of this review is to establish the role of endopyelotomy in the age of laparoscopic and robot-assisted laparoscopic pyeloplasty (RALP). Open pyeloplasty (OP) has been the gold standard of care for UPJO for the past six decades. Due to lower long-term efficacy, endopyelotomy has failed to replace OP. However, laparoscopic pyeloplasty (LP) has been able to reproduce the high success rates of OP, while also achieving minimal morbidity. Unfortunately, the steep learning curve and technical difficulties have hindered its use. Recently, robot-assisted systems have enabled LP to overcome its disadvantages, and this may render endopyelotomy obsolete. Although LP and RALP are emerging as the gold standard of treatment for UPJO, endopyelotomy could carve out a niche area as a salvage procedure. Endopyelotomy will continue to have a role in the management of UPJO, albeit a smaller one.
Collapse
Affiliation(s)
- Daniel Yong
- Division of Urology, Department of Surgery, Duke University Medical Center, Room 1112, Green Zone, DUMC #3457, Durham, NC, 27710, USA
| | | |
Collapse
|
15
|
Kawauchi A, Kamoi K, Soh J, Naitoh Y, Okihara K, Miki T. Laparoendoscopic single-site urological surgery: Initial experience in Japan. Int J Urol 2010; 17:289-92. [DOI: 10.1111/j.1442-2042.2010.02470.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
16
|
Hall RM, Murphy DG, Challacombe B, Costello AJ, Kearsley J. Robotic-assisted laparoscopic pyeloplasty: initial Australasian experience. J Robot Surg 2009; 3:209-13. [PMID: 27628631 DOI: 10.1007/s11701-009-0163-5] [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] [Received: 06/08/2009] [Accepted: 11/04/2009] [Indexed: 10/20/2022]
Abstract
Laparoscopic dismembered pyeloplasty has a success rate in excess of 90% for the treatment of uretero-pelvic junction (UPJ) obstruction. Laparoscopic intracorporeal suturing, however, remains technically challenging and may lead to prolonged operating times. Robotic-assisted suturing using the da Vinci(®) surgical system (Intuitive Surgical, CA, USA) may reduce the difficulty associated with intra-corporeal suturing. The da Vinci(®) surgical system was used to facilitate intra-corporeal suturing in adults undergoing trans-peritoneal robotic-assisted laparoscopic pyeloplasty (RALPY) at our institution. Initially, the robot was only docked for the anastomosis, but in the later part of the series the robot was used for all parts of the dissection and reconstruction. Peri-operative and outcome data were recorded prospectively. Twenty-four patients underwent RALPY over a 4-year period. The mean age was 46.6 (range 18-76) years. The mean total operative time was 211 min (range 150-317 min) with an anastomotic time of 44 min (range 30-55 min). The mean estimated blood loss was 56 ml (10-150 ml) and there was one temporary urine leak managed by 24 h of urethral catheterization. The median length of stay was 4 (2-10) days. Patients underwent diuretic renography at 6 months post surgery, and satisfactory renal drainage was demonstrated in all cases. RALPY is a feasible and safe option for the management of UPJ obstruction. This technology may reduce the difficulty associated with complex laparoscopic suturing and facilitate shorter operative times with excellent outcomes. This is now our preferred approach for all patients opting for surgical management of UPJ obstruction.
Collapse
Affiliation(s)
- Rohan Matthew Hall
- Departments of Urology, Epworth Hospital, Richmond, VIC, Australia. .,Department of Urology, Royal Melbourne Hospital, Grattan Street, Parkville, VIC, 3052, Australia.
| | - Declan G Murphy
- Departments of Urology, Epworth Hospital, Richmond, VIC, Australia.,Department of Urology, Royal Melbourne Hospital, Grattan Street, Parkville, VIC, 3052, Australia
| | - Ben Challacombe
- Departments of Urology, Epworth Hospital, Richmond, VIC, Australia.,Department of Urology, Royal Melbourne Hospital, Grattan Street, Parkville, VIC, 3052, Australia
| | - Anthony J Costello
- Departments of Urology, Epworth Hospital, Richmond, VIC, Australia.,Department of Urology, Royal Melbourne Hospital, Grattan Street, Parkville, VIC, 3052, Australia
| | - Jamie Kearsley
- Departments of Urology, Epworth Hospital, Richmond, VIC, Australia.,Department of Urology, Royal Melbourne Hospital, Grattan Street, Parkville, VIC, 3052, Australia
| |
Collapse
|
17
|
Holmium laser endoureterotomy for benign ureteral stricture: a single center experience. J Urol 2009; 182:2775-9. [PMID: 19837432 DOI: 10.1016/j.juro.2009.08.051] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2009] [Indexed: 11/20/2022]
Abstract
PURPOSE We assessed the long-term outcome of laser endoureterotomy for benign ureteral stricture. MATERIALS AND METHODS From a database of 69 patients who underwent retrograde laser endoureterotomy from October 2001 to June 2007 we identified 35 with a benign ureteral stricture. Clinical characteristics, operative results and functional outcomes were investigated. Success was defined as symptomatic improvement and radiographic resolution of obstruction. RESULTS Median followup was 27 months (range 10 to 72). All except 1 patient were followed at least 16 months. All patients completed clinical followup and 33 completed imaging. Of 35 patients 29 (82%) were symptom-free during followup and 26 of 33 (78.7%) were free of radiographic evidence of obstruction. All except 1 failure occurred within less than 9 months postoperatively. The success rate was higher for nonischemic strictures (100% vs 64.7%, p = 0.027) and tended to be higher for strictures 1 cm or less (89.4% vs 64.2%, p = 0.109). CONCLUSIONS Holmium laser endoureterotomy is effective for benign ureteral stricture in well selected patients. Most failures occur within less than 9 months after surgery, which may indicate a need for closer followup during postoperative year 1. Factors that might may outcome are ischemia and stricture length.
Collapse
|
18
|
Nayyar R, Gupta NP, Hemal AK, Kumar R. Two Concomitant Robot-Assisted Procedures in One Anesthesia Session: Our Experience. J Endourol 2009; 23:263-7. [DOI: 10.1089/end.2008.0481] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Rishi Nayyar
- Department of Urology, All India Institute of Medical Sciences, New Delhi, India
| | - Narmada P. Gupta
- Department of Urology, All India Institute of Medical Sciences, New Delhi, India
| | - Ashok K. Hemal
- Department of Urology, All India Institute of Medical Sciences, New Delhi, India
| | - Rajeev Kumar
- Department of Urology, All India Institute of Medical Sciences, New Delhi, India
| |
Collapse
|