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Chen Z, Wang Y, Wu C, Chen H, Cui X, Zhou C. Double J stent combined with pyelostomy tube in pediatric laparoscopic pyeloplasty: a 5-year clinical experience in a single center. BMC Urol 2023; 23:181. [PMID: 37940873 PMCID: PMC10634194 DOI: 10.1186/s12894-023-01351-1] [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: 11/06/2022] [Accepted: 10/25/2023] [Indexed: 11/10/2023] Open
Abstract
OBJECTIVE To compare the outcome of using a double J (DJ) stent combined with pyelostomy tube with a DJ stent alone in laparoscopic pyeloplasty (LP) for pediatric ureteropelvic junction obstruction (UPJO). METHODS A retrospective review of all patients with UPJO treated with LP between January 2017 and November 2021 was conducted in our center. According to different postoperative drainage methods patients were divided into a DJ stent group (52 cases) and a DJ stent combined with pyelostomy tube group (combination group, 41 cases). Operative time, bleeding volume, perirenal drainage stent removal time, postoperative hospital stay, postoperative complications, and renal function recovery were compared between the two groups. Renal ultrasound and diuretic renogram (DR) were used for preoperative and postoperative follow-up. RESULTS A total of 52 patients were in the DJ stent group and 41 patients in the combination group. The mean hospital stay was 6.46 ± 2.66 days in the DJ stent group and 5.22 ± 1.63 days in the combination group (p < 0.05). Postoperative complications developed in 14 out of 52 patients in the DJ stent group (26.9%), while complications developed in 8 out of 41 patients in the combination group (19.5%) (p > 0.05). Non-catheter-related complications developed in 10/52 patients in the DJ stent group (19.2%) and only 1/41 patients in the combination group (2.4%) (p < 0.05). The renal function and renal cortex thickness in both groups were improved. CONCLUSION Both the DJ stent drainage and the DJ stent combined with pyelostomy drainage are safe and effective. We should fully consider the patient's preoperative and intraoperative conditions and choose appropriate drainage methods. A DJ stent combined with pyelostomy tube can reduce non-catheter related complications, facilitate postoperative recovery, and the hospital stay was significantly shorter than the DJ stent group. However, it is necessary to pay attention to the nursing treatment of the pyelostomy tube and guard against the occurrence of pyelostomy tube shedding.
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Affiliation(s)
- Zhiqiang Chen
- Fujian Children's Hospital (Fujian Branch of Shanghai Children's Medical Center), College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
| | - Yunjin Wang
- Fujian Children's Hospital (Fujian Branch of Shanghai Children's Medical Center), College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
| | - Changwei Wu
- Fujian Children's Hospital (Fujian Branch of Shanghai Children's Medical Center), College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
| | - Hong Chen
- Fujian Children's Hospital (Fujian Branch of Shanghai Children's Medical Center), College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
| | - Xu Cui
- Fujian Children's Hospital (Fujian Branch of Shanghai Children's Medical Center), College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China.
| | - Chaoming Zhou
- Fujian Children's Hospital (Fujian Branch of Shanghai Children's Medical Center), College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China.
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He J, Lai H, Zhang T, Ye L, Yao B, Qu H, Ma B, Guo Q, Zhang Y, Qiu J, Wang D. Enhanced recovery management in pediatric pyeloplasty: outcomes in a single institution and tips for improvement. World J Urol 2023; 41:1667-1673. [PMID: 37219585 DOI: 10.1007/s00345-023-04422-y] [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: 09/12/2022] [Accepted: 04/25/2023] [Indexed: 05/24/2023] Open
Abstract
OBJECTIVE We report the application of enhanced recovery after surgery (ERAS) regimens to pediatric patients undergoing laparoscopic pyeloplasty (LP), aiming to guide the practice of ERAS in pediatric LP. METHODS From October 2018, we prospectively implemented a twenty-point ERAS regimen, including a modified LP procedure, for pediatric UPJO patients in a single institution. Data from 2018 to 2021 were collected and analyzed retrospectively. The variables gathered included: demographics, preoperative details and recovery elements. Outcomes were postoperative length of stay (POS), readmission rate, operation time and blood loss. RESULTS A total of 75 pediatric patients (0-14 years) were included. The mean POS was 2.4 ± 1.4 days, shorter than that in recent studies in China (3.3 ± 1.4 days, 6 (3-16) days). None were redo, and six restenosis (8%) were improved after treatment with ureteral balloon dilatation. The mean operation time was 257.9 ± 54.4 min, and blood loss was 11.8 ± 10.0 ml. In the univariable analysis and multivariable analysis, no external drainage, sacral anesthesia, and withdrawal of the catheter on day one were independently associated with a POS of ≤ 2 d (p < 0.05). CONCLUSION The implementation of this ERAS protocol for pediatric LP has resulted in a shorter length of stay without a higher readmission rate. Surgery techniques, drainage management and analgesia are the key to further improvement. ERAS for pediatric pyeloplasty should be encouraged.
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Affiliation(s)
- Jiannan He
- Department of Urology, The Sixth Affiliated Hospital, Sun Yat-Sen University, Yuancun Erheng Road 26, Guangzhou, 510655, Guangdong, China
| | - Huajian Lai
- Department of Urology, The Sixth Affiliated Hospital, Sun Yat-Sen University, Yuancun Erheng Road 26, Guangzhou, 510655, Guangdong, China
| | - Tianyou Zhang
- Department of Urology, The Sixth Affiliated Hospital, Sun Yat-Sen University, Yuancun Erheng Road 26, Guangzhou, 510655, Guangdong, China
| | - Lei Ye
- Department of Urology, The Sixth Affiliated Hospital, Sun Yat-Sen University, Yuancun Erheng Road 26, Guangzhou, 510655, Guangdong, China
| | - Bing Yao
- Department of Urology, The Sixth Affiliated Hospital, Sun Yat-Sen University, Yuancun Erheng Road 26, Guangzhou, 510655, Guangdong, China
| | - Hu Qu
- Department of Urology, The Sixth Affiliated Hospital, Sun Yat-Sen University, Yuancun Erheng Road 26, Guangzhou, 510655, Guangdong, China
| | - Bo Ma
- Department of Urology, The Sixth Affiliated Hospital, Sun Yat-Sen University, Yuancun Erheng Road 26, Guangzhou, 510655, Guangdong, China
| | - Qiang Guo
- Department of Urology, The Sixth Affiliated Hospital, Sun Yat-Sen University, Yuancun Erheng Road 26, Guangzhou, 510655, Guangdong, China
| | - Yifei Zhang
- Department of Urology, The Sixth Affiliated Hospital, Sun Yat-Sen University, Yuancun Erheng Road 26, Guangzhou, 510655, Guangdong, China
| | - Jianguang Qiu
- Department of Urology, The Sixth Affiliated Hospital, Sun Yat-Sen University, Yuancun Erheng Road 26, Guangzhou, 510655, Guangdong, China.
| | - Dejuan Wang
- Department of Urology, The Sixth Affiliated Hospital, Sun Yat-Sen University, Yuancun Erheng Road 26, Guangzhou, 510655, Guangdong, China.
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A Comparative Analysis of Robot-Assisted Laparoscopic Pyeloplasty in Pediatric and Adult Patients: Does Age Matter? J Clin Med 2022; 11:jcm11195651. [PMID: 36233520 PMCID: PMC9570754 DOI: 10.3390/jcm11195651] [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] [Received: 09/04/2022] [Revised: 09/19/2022] [Accepted: 09/21/2022] [Indexed: 11/29/2022] Open
Abstract
We investigated factors that affect the surgical outcomes of robotic pyeloplasty by comparing the surgical results of pediatric and adult patients with ureteropelvic junction stricture (UPJO). We retrospectively reviewed patients who underwent robotic pyeloplasty for UPJO between January 2013 and February 2022. The patients were categorized into two groups: the pediatric (≤18 years) and adult (>18 years) groups. The perioperative and postoperative outcomes and surgical complications were comparatively analyzed. Prognostic factors for predicting surgical failure were analyzed with multivariable logistic regression analysis. The pediatric group showed longer total operation and console times. The mean pain score was lower in the pediatric group than in the adult group on days 1 and 2 after surgery. The average amount of morphine used in the pediatric group was lower during postoperative days 0−2. No differences in the length of hospital stay, incidence of surgical failure, and incidence of urolithiasis requiring treatment after robotic pyeloplasty were observed between the groups. The only factor that predicted surgical failure was a history of urolithiasis before surgery. The results showed that age did not affect the surgical outcome.
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Whiting D, Whitehurst L, Tsang D, Hussain M, Malki M, Barber NJ. Retroperitoneal robotic-assisted laparoscopic pyeloplasty: A 10 year experience in a single institution. J Endourol 2021; 36:615-619. [PMID: 34931543 DOI: 10.1089/end.2021.0551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Introduction Pelvi-ureteric junction (PUJ) obstruction was traditionally treated with open pyeloplasty. In recent decades the development of minimally invasive techniques; including laparoscopic and later robotic surgery, has transformed treatment. The transperitoneal approach has most commonly been undertaken with few institutions reporting outcomes of the retroperitoneal approach. We report our 10 year experience of retroperitoneal robotic-assisted laparoscopic pyeloplasty (R-RALP). Methods A prospective database of 160 patients undergoing RALP between February 2010 and November 2019 was analysed. Data was recorded on demographics, operative details, complications and success rate. Success was determined as symptomatic improvement and/or an unobstructed renogram. Results 152 cases (95.0%) were performed using a retroperitoneal approach and 8 (5.0%) transperitoneal. Mean age was 45.317.4 years. Mean operating time was 139.445.6 minutes. A surgical drain was placed in 57 (71.3%) of the first 80 cases and 15 (18.8%) of the second 80 cases. Median hospital stay was 1 night (range 1-27). One case was converted to open pyeloplasty due to dense inflammatory tissue and one to robotic-assisted nephrectomy due to severe adhesions around the PUJ. There were no blood transfusions. There were 6 major (>grade 2 Clavien-Dindo) post-operative complications in 4 patients (2.5%). Two (1.3%) grade 3a complications: urine leak and pain after stent removal requiring nephrostomy. Three (1.9%) grade 3b complications: migrated stent requiring ureteroscopy, perirenal haematoma requiring open evacuation and stent re-insertion. One (0.6%) grade 4 complication requiring ventilatory support on intensive care. 18 patients received follow-up at an alternative hospital and 13 were lost to follow-up. Of the remaining cases 94.5% were successful. Conclusions R-RALP is a safe and effective treatment for PUJ obstruction allowing predictably rapid discharge from hospital without the need for a routine surgical drain. To our knowledge our study represents the largest single institution experience on RALP using a retroperitoneal approach.
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Affiliation(s)
- Danielle Whiting
- Frimley Park Hospital NHS Trust, 2133, Frimley, Surrey, United Kingdom of Great Britain and Northern Ireland;
| | - Lily Whitehurst
- Frimley Park Hospital NHS Trust, 2133, Urology, Frimley, Surrey, United Kingdom of Great Britain and Northern Ireland;
| | - Derrick Tsang
- Frimley Park Hospital NHS Trust, 2133, Urology, Frimley, Surrey, United Kingdom of Great Britain and Northern Ireland;
| | - Muddassar Hussain
- Frimley Park Hospital NHS Trust, 2133, Urology, Frimley, Surrey, United Kingdom of Great Britain and Northern Ireland;
| | - Manar Malki
- Frimley Park Hospital NHS Trust, 2133, Urology, Frimley, Surrey, United Kingdom of Great Britain and Northern Ireland;
| | - Neil J Barber
- Frimley Park Hospital NHS Trust, 2133, Urology, Frimley, Surrey, United Kingdom of Great Britain and Northern Ireland;
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Song P, Shu M, Peng Z, Yang L, Zhou M, Wang Z, Lu N, Pei C, Dong Q. Transperitoneal versus retroperitoneal approaches of pyeloplasty in management of ureteropelvic junction obstruction: A meta-analysis. Asian J Surg 2021; 45:1-7. [PMID: 33867239 DOI: 10.1016/j.asjsur.2021.03.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 03/04/2021] [Accepted: 03/26/2021] [Indexed: 02/08/2023] Open
Abstract
The aim of this study was to evaluate the benefits and safety of transperitoneal and retroperitoneal pyeloplasty for ureteropelvic junction obstruction by a meta-analysis. We searched the databases including PubMed, Cochrane Library and Embase database from their inception to December 1st, 2020. Relevant literatures comparing retroperitoneal pyeloplasty with transperitoneal pyeloplasty were identified. A meta-analysis was conducted with Revman 5.3. The main outcomes included success rate, operative time, hospital stay, conversion rate of open surgery, overall complications, and detailed postoperative complications/indicators. 15 studies with 1881 patients were included. The results revealed that there were no significant differences between two approaches in success rate [OR = 1.51, 95%CI (0.94, 2.41), p = 0.09], hospital stay [MD = 0.21, 95%CI (-0.12, 0.54), p = 0.21] and overall complications [OR = 1.07, 95%CI (0.76, 1.50), p = 0.69]. The retroperitoneal approach was associated with longer operative time [MD = -26.91, 95%CI (-40.97, -12.84), p < 0.001], higher conversion rate [OR = 0.23, 95%CI (0.11, 0.47), p < 0.001] than the transperitoneal approach. As for the detailed postoperative complications/indicators, there were no significant differences between two approaches in the urinary leak, mild hematuria, fever, UPJO recurrence, infection and subcutaneous emphysema, as well as split renal function, renal pelvis anteroposterior diameter. The funnel plots showed that there were no obvious publication biases in our analysis. Therefore, we concluded that transperitoneal and retroperitoneal approaches had similar benefits and safety in success rate, hospital stay, overall complications and detailed postoperative complications/indicators. However, retroperitoneal was associated with longer operative time and higher conversion rate than transperitoneal approach. With the limitations of our study, additional high-quality studies are still essential for further evaluation.
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Affiliation(s)
- Pan Song
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan Province, China
| | - Mengxuan Shu
- The First Clinical Medical College of Lanzhou University, Lanzhou, 730000, Gansu Province, China
| | - Zhufeng Peng
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan Province, China
| | - Luchen Yang
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan Province, China
| | - Mingzhen Zhou
- The Second Clinical Medical College of Lanzhou University, Lanzhou, 730000, Gansu Province, China
| | - Zirui Wang
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan Province, China
| | - Ni Lu
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan Province, China
| | - Caixia Pei
- The First Clinical Medical College of Lanzhou University, Lanzhou, 730000, Gansu Province, China
| | - Qiang Dong
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan Province, China.
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Verma S, Saxena P, Singh SK, Khandpur S, Deswal S, Kumar N, Singh A. To evaluate the minimum number of renal scans required to follow pediatric patient postpyeloplasty. World J Nucl Med 2020; 19:106-110. [PMID: 32939196 PMCID: PMC7478307 DOI: 10.4103/wjnm.wjnm_3_19] [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: 01/09/2019] [Accepted: 04/05/2019] [Indexed: 11/16/2022] Open
Abstract
The aim of the study is to evaluate the minimum number of renal scans required to follow pediatric patients postpyeloplasty. We prospectively reviewed the renal scans of 145 children with unilateral pelvi-ureteric junction obstruction who underwent dismembered pyeloplasty. Patients were then divided into four groups based on preoperative split renal function. All patients were followed with renal scan and ultrasound for minimum of 4 years. Renal scan and ultrasound were done after stent removal at 3, 6, and 12 months and then yearly after surgery. Drainage pattern (T1/2) was seen in all groups, except in patients where there was no comment on drainage pattern. Statistical analysis was performed using the Friedman ANOVA and Wilcoxon signed-ranks test as a post hoc test with Bonferroni correction and Kruskal–Wallis test with Mann–Whitney U-test as a post hoc test with Bonferroni correction. On comparison of the pattern of drainage with time in Groups 1–4, it was found that there was no significant difference with time in Group 1. Then, further, using Wilcoxon signed-rank test as post hoc test for Friedman ANOVA, Group 2 showed statistically significant difference in drainage pattern in scans between 6 months and 1 year, Group 3 showed statistically significant difference in drainage pattern in scans between 3 months and 1 year, and Group 4 showed statistically significant difference in drainage pattern in scans done between 3 and 6 months (P < 0.05). Minimum of three renal scans were required for paediatric patients post pyeloplasty at 3 months, 6 months and 1 year in the follow up period.
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Affiliation(s)
- Shashwat Verma
- Department of Nuclear Medicine, Chandan Hospital, Lucknow, Uttar Pradesh, India
| | - Payal Saxena
- Department of Obstetrics and Gynaecology, Chandan Hospital, Lucknow, Uttar Pradesh, India
| | | | - Sukhanshi Khandpur
- Department of Statistics, Lucknow University, Lucknow, Uttar Pradesh, India
| | - Satyawati Deswal
- Department of Nuclear Medicine, Chandan Hospital, Lucknow, Uttar Pradesh, India
| | - Narvesh Kumar
- Department of Nuclear Medicine, Apollo Medics, Lucknow, Uttar Pradesh, India
| | - Anjana Singh
- Department of Pathology, Mayo Institute of Medical Sciences, Barabanki, Uttar Pradesh, India
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Liu X, Huang C, Guo Y, Yue Y, Hong J. Comparison of DJ stented, external stented and stent-less procedures for pediatric pyeloplasty: A network meta-analysis. Int J Surg 2019; 68:126-133. [DOI: 10.1016/j.ijsu.2019.07.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 06/12/2019] [Accepted: 07/03/2019] [Indexed: 01/08/2023]
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Radfar MH, Afyouni A, Shakiba B, Hamedanchi S, Zare A. A New Touchless Technique for Suturing in Transperitoneal Laparoscopic Pyeloplasty. J Laparoendosc Adv Surg Tech A 2019; 29:519-522. [PMID: 30724706 DOI: 10.1089/lap.2018.0635] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The most difficult, time-consuming, and critical steps of laparoscopic pyeloplasty (LPP) are ureteral spatulation, apical ureteral stitch placement, and ureteropelvic anastomosis. To simplify these critical steps, avoid the risk of ureteral shortening, and also minimize ureteral manipulation, we present a modified dismembered technique for suturing with the outcome of patients who underwent LPP using this technique. MATERIALS AND METHODS This study included 23 patients who were candidates for transperitoneal dismembered Anderson-Hynes LPP. The ureter was partially cut just below the ureteropelvic junction. The ureter was spatulated at its lateral aspect to cross the obstruction site and reach the normal ureter. The renal pelvis was obliquely cut equal to the size of ureteral spatulation. The ureter and pelvis were still connected partially. At this point, the first stitch was placed between the lower point of the spatulated ureter and the lowest corner of the renal pelvis. Anastomosis was performed by running sutures. RESULTS No cases of internal organ injury and no cases of open surgery conversion were encountered. The radiologic success rate was 96%. After operation, in 1 patient, obstruction still existed and the patient underwent nephrectomy due to a nonfunctional obstructive kidney. CONCLUSIONS This modification preserves total ureteral length and facilitates spatulation and suturing in transperitoneal laparoscopic dismembered pyeloplasty. The results showed that it is a useful method, especially for less-experienced surgeons.
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Affiliation(s)
- Mohammad Hadi Radfar
- 1 Urology and Nephrology Research Center, Shahid Labbafinejad Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Amir Afyouni
- 1 Urology and Nephrology Research Center, Shahid Labbafinejad Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Behnam Shakiba
- 1 Urology and Nephrology Research Center, Shahid Labbafinejad Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sepehr Hamedanchi
- 2 Department of Urology, Imam Khomeini Hospital, Urmia University of Medical Sciences, Urmia, Iran
| | - Ali Zare
- 1 Urology and Nephrology Research Center, Shahid Labbafinejad Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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A modified suture technique for transperitoneal laparoscopic dismembered pyeloplasty of pelviureteric junction obstruction. Urology 2015; 85:263-7. [PMID: 25530399 DOI: 10.1016/j.urology.2014.09.031] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2014] [Revised: 08/12/2014] [Accepted: 09/23/2014] [Indexed: 12/28/2022]
Abstract
OBJECTIVE To describe a modified suture technique for transperitoneal laparoscopic dismembered pyeloplasty (TPLDP) that can be consistently replicated. METHODS Between June 2010 and April 2014, 21 men and 7 women with primary pelviureteric junction obstruction underwent our modified TPLDP suture technique performed by the same surgeon. In our method, the dismembering should be performed after performing half of anastomosis to achieve the maintenance of correct orientation and the prevention of torsion of anastomosis. We defined the success criteria as complete clinical resolution of flank pain for the patients with flank pain and complete radiologic resolution for the asymptomatic patients. RESULTS The mean overall operative time for our technique was 137.3 minutes. The mean operative time for procedures on the left side was longer than on the right side (P = .02). The mean suture time was 37.2 minutes. The mean estimated blood loss was 29.4 mL, and the crossing vessel was found in 7 of 28 patients (25.0%). No open conversion was required. The mean follow-up time was 21.0 months. Only 1 patient still had frequent and intolerable flank pain after surgery whose treatment was unsuccessful. The rest of the patients got complete clinical or radiologic resolution. The success rate was 27 of 28 (96.4%). CONCLUSION Our modified TPLDP suture technique is feasible and seems to be safe and to allow high success rate for the treatment of pelviureteric junction obstruction. Sizable sample and further analysis about technique will be completed in the future.
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Di Gregorio M, Botnaru A, Bairy L, Lorge F. Passing from open to robotic surgery for dismembered pyeloplasty: a single centre experience. SPRINGERPLUS 2014; 3:580. [PMID: 25332880 PMCID: PMC4201660 DOI: 10.1186/2193-1801-3-580] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/22/2014] [Accepted: 09/19/2014] [Indexed: 12/02/2022]
Abstract
BACKGROUND The treatment of symptomatic uretropelvic junction obstruction (UPJO) has evolved towards minimal invasive endourologic and laparoscopic techniques. Robotic assisted laparoscopic pyeloplasty has achieved outcomes comparable to those corresponding to open and laparoscopic techniques. The objective of this work is to demonstrate that the transition between open to robotic surgeries is straightforward. We analysed retrospectively "our initial results" in robotic assisted UPJ reconstruction procedures. Technical and convalescence aspects for 17 reconstructive robotic procedures performed by 2 surgeons in a 5 years period have been evaluated. Success consisted of no postoperative symptoms, no evidence of obstruction on mercaptoacetyltriglycine-3 diuretic renal scan or computed tomography (CT) and non-further treatment. STATISTICS mean ± standard deviation, median and range. FINDINGS From 17 patients who underwent Da Vinci Robot procedure, 15 followed the complete treatment (2 were converted to laparotomy). Two patients had post-operative urine leakage; the stent was changed under sedation without further sequelae. The mean operative time was 189 minutes. The average hospital stay was 4 days. The average follow-up was 25 months. There was only one patient with UPJ stenosis at 6 months and he was treated by balloon dilation. All patients were followed with MAG 3 lasix renal scan, CT or urography. Except the patient with recurrent stenosis, all patients were asymptomatic without objective evidence of obstruction at the present time. CONCLUSIONS Robotic pyeloplasty technique is feasible and gives good results without previous laparoscopic experience.
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Affiliation(s)
- Marcelo Di Gregorio
- />Urology Department, Cliniques universitaires UCL Dinant-Godinne, Université Catholique de Louvain, 1 Av Gaston Thérasse, Yvoir, Belgium
| | - Andrei Botnaru
- />Urology Department, Cliniques universitaires UCL Dinant-Godinne, Université Catholique de Louvain, 1 Av Gaston Thérasse, Yvoir, Belgium
| | - Laurent Bairy
- />Aenesthesia Department, Cliniques universitaires UCL Dinant-Godinne, Université Catholique de Louvain, 1 Av Gaston Thérasse, Yvoir, Belgium
| | - Francis Lorge
- />Urology Department, Cliniques universitaires UCL Dinant-Godinne, Université Catholique de Louvain, 1 Av Gaston Thérasse, Yvoir, Belgium
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Singh SK, Kumar J, Sachin AN, Kapoor R, Srivastava A, Ansari MS. Prospective randomized study to evaluate the feasibility and outcome of transmesocolic laparoscopic pyeloplasty and compare it with retrocolic laparoscopic pyeloplasty in pediatric and adolescent patients. Indian J Urol 2014; 30:263-7. [PMID: 25097310 PMCID: PMC4120211 DOI: 10.4103/0970-1591.128499] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE This prospective randomized study was designed to evaluate the feasibility and outcome of transmesocolic laparoscopic pyeloplasty (TMP) and compare it with retrocolic laparoscopic pyeloplasty (RLP) in pediatric and adolescent patients. MATERIALS AND METHODS Between September 2006 to May 2012, data of pediatric and adolescent patients undergoing laparoscopic pyeloplasty were recorded in a prospective manner. Data included age, pelvic volume, presence of stones, aberrant vessels, operative time, analgesics requirement and time to accept oral feeds and drain removal. Patients with left side pelviureteric junction obstruction with any size of pelvic volume, with or without renal stones and aberrant vessels were included in the study. Patients were assigned into two groups by simple randomization technique. A total of 38 TMP and 41 left sided RLP were performed. Median follow-up period for transmesocolic group was 12.5 months (9.5-62 months) and 14 months (8-66 months) for retro colic group. Outcome for this study was adequate drainage on renal scan, improvement in symptom and or resolution of hydronephrosis on ultrasound. Statistical analysis was performed using the Mann-Whitney test. RESULTS The mean patient age was 8.73 years in RLP and 7.73 years in TMP. In RLP group the mean operative time was 75.84 min (time from port insertion to pyeloplasty) and 135.4 min (total operative time) while it was 44.82 min and 104.82 min respectively in TMP group. Compared with classic RLP, TMP cases showed a significant reduction in operative time. CONCLUSIONS The transmesocolic approach for left sided pyeloplasty enables a shorter operative time even in the presence of large pelvis, aberrant vessel and stones without increasing morbidity in comparison to RLP approach.
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Affiliation(s)
- Sanjeet Kumar Singh
- Department of Urology and Renal Transplantation, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Jatinder Kumar
- Department of Urology and Renal Transplantation, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - A N Sachin
- Department of Urology and Renal Transplantation, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Rakesh Kapoor
- Department of Urology and Renal Transplantation, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Aneesh Srivastava
- Department of Urology and Renal Transplantation, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - M S Ansari
- Department of Urology and Renal Transplantation, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
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Warren J, da Silva V, Caumartin Y, Luke PPW. Robotic renal surgery: The future or a passing curiosity? Can Urol Assoc J 2013; 3:231-240. [PMID: 19543471 DOI: 10.5489/cuaj.1080] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
The development, advancement and clinical integration of robotic technology in surgery continue at a staggering pace. In no other discipline has this rapid evolution occurred to a greater degree than in urology. Although radical prostatectomy has grown to become the prototypical application for the robot, the role of the robot in renal surgery remains controversial. Herein we review the literature on robotic renal surgery. A comprehensive PubMed literature search was performed to identify all published reports relating to robotic renal surgery. All clinically related articles involving human participants were critically appraised in this review. Fifty-one clinical articles were included, encompassing robot-assisted pyeloplasty, nephrectomy, nephroureterectomy, living-donor nephrectomy and partial nephrectomy. Feasibility has been shown for each of these procedures. Robot-assisted techniques have been described for almost all renal-related procedures. However, the intersect between feasibility and necessity as it pertains to robotic renal surgery has yet to be defined. Also, the high cost of surgical robotic technology mandates critical appraisal before adoption, especially in a publicly funded health care system, such as the one present in Canada.
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Affiliation(s)
- Jeff Warren
- Department of Surgery, Division of Urology, University of Western Ontario
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Abraham GP, Das K, Ramaswami K, Siddaiah AT, George DP, Abraham JJ, Thampan OS. Transperitoneal laparoscopic dismembered pyeloplasty in unusual circumstances--is the outcome comparable to that achieved in familiar pathologies? Urology 2012; 79:1057-62. [PMID: 22546383 DOI: 10.1016/j.urology.2012.01.041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2011] [Revised: 01/23/2012] [Accepted: 01/27/2012] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To compare the operative outcome, morbidity profile, and functional outcome after transperitoneal laparoscopic dismembered pyeloplasty for ureteropelvic junction obstruction in unusual circumstances (intrinsic pathology in anomalous kidneys or unusual extrinsic pathologies; group 1) to the outcome after this procedure in familiar pathologies (normally located kidneys with intrinsic dysfunctional segment or extrinsic compression due to a crossing vessel; group 2). METHODS The patients were evaluated in detail. All patients underwent transperitoneal laparoscopic dismembered pyeloplasty. The operative and postoperative parameters were recorded. Patients were followed up after the procedure on a 3-month protocol. Imaging was repeated at 1 year. No intervention during the follow-up period (ie, nephrostomy, ureteral stenting, or redo pyeloplasty) and improvement in the hydronephrosis grade and diuretic renogram parameters was interpreted as procedural success. The operative, postoperative, and follow-up parameters in the 2 groups were compared. RESULTS Group 1 included 17 patients with intrinsic pathologic features and renal anomalies with ureteropelvic junction obstruction due to unusual extrinsic pathology. All procedures were successfully completed with the laparoscopic approach. A significant difference was noted in the mean operative duration (group 1, 196.9 ± 10.3 minutes; group 2, 125.44 minutes, P = .00). The other operative and postoperative parameters were comparable. No significant operative or postoperative events were noted. A total of 14 patients (group 1) completed the 1-year follow-up protocol. The success rate was 92.9% (13 of 14) in group 1 and 97.9% (44 of 45) in group 2 (P = .42). CONCLUSION The procedural duration for laparoscopic dismembered pyeloplasty in unusual circumstances is longer than in familiar pathologies. However, the morbidity profile and functional outcome in these 2 scenarios were comparable.
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Bentani N, Moudouni S, Wakrim B, Amine M, Hanich T, Saghir O, Barjani F, Lakmichi M, Dahami Z, Sarf I. Cure du syndrome de Jonction Pyelo-Ureterale par voie laparoscopique : Résultats et clés du succès au cours de la courbe d'apprentissage. AFRICAN JOURNAL OF UROLOGY 2012. [DOI: 10.1016/j.afju.2012.04.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Valero R, Moanack J, Cruz G, Sánchez-Ismayel A, Sánchez-Salas R, García-Seguí A. [Animal model for training in laparoscopic pyeloplasty]. Actas Urol Esp 2012; 36:54-9. [PMID: 22032893 DOI: 10.1016/j.acuro.2011.06.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2011] [Accepted: 06/14/2011] [Indexed: 10/26/2022]
Abstract
OBJECTIVE With the coming of the laparoscopy, multiple surgical techniques have been developed that have revolutionized the urological practice. The laparoscopic pyeloplasty has been one of the techniques most developed. However, there are very few training models that permit the surgeon to decrease the learning curve. An animal model of training for the laparoscopic pyeloplasty technique is described. METHODS Eight procedures of laparoscopic pyeloplasty were performed using the animal model (Gallus gallus) in the laparoscopic practice laboratory of the Urology Service of the University Hospital of Caracas. The preparation times of the model and the operation times of each surgeon were compared. The statistical analysis was made calculating the mean operation time, standard deviation, frequencies and percentages. A significant value was considered as p < 0.05. RESULTS The laparoscopic pyeloplasty procedure was performed successfully in all of the cases by two surgeons. The preparation time ranged from a maximum of 14 minutes to a minimum of 6 minutes, this being the same for both surgeons in the fourth case. The operation time ranged from a maximum of 65 minutes to a minimum of 43 minutes, observing significant differences when comparing the times individually for each surgeon. Only one case had filtration when comparing the patency of the specimen. CONCLUSIONS The animal model of training of laparoscopic pyeloplasty that is described is economical, reproducible, of easy availability and it makes it possible to develop laparoscopic surgical skills and competency necessary for reconstructive surgery and techniques that warrant intracorporeal suture.
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Bilen CY, Bayazit Y, Güdeloğlu A, Abat D, Inci K, Doran S. Laparoscopic Pyeloplasty in Adults: Stented Versus Stentless. J Endourol 2011; 25:645-50. [DOI: 10.1089/end.2010.0401] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Cenk Y. Bilen
- Department of Urology, Hacettepe University School of Medicine, Ankara, Turkey
| | - Yildirim Bayazit
- Department of Urology, Cukurova University School of Medicine, Adana, Turkey
| | - Ahmet Güdeloğlu
- Department of Urology, Hacettepe University School of Medicine, Ankara, Turkey
| | - Deniz Abat
- Department of Urology, Cukurova University School of Medicine, Adana, Turkey
| | - Kubilay Inci
- Department of Urology, Hacettepe University School of Medicine, Ankara, Turkey
| | - Saban Doran
- Department of Urology, Cukurova University School of Medicine, Adana, Turkey
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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]
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Erdeljan P, Caumartin Y, Warren J, Nguan C, Nott L, Luke PPW, Pautler SE. Robot-assisted pyeloplasty: follow-up of first Canadian experience with comparison of outcomes between experienced and trainee surgeons. J Endourol 2011; 24:1447-50. [PMID: 20677915 DOI: 10.1089/end.2009.0617] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND AND PURPOSE Robot-assisted pyeloplasty (RAP) has been established recently as an option in the management of ureteropelvic junction obstruction (UPJO). We present the first Canadian experience with RAP with respect to operative results and outcomes. We compare the surgical outcomes between experienced and trainee surgeons, with respect to operating room times and success rates. PATIENTS AND METHODS Eighty-eight patients underwent transperitoneal RAP for UPJO using the da Vinci robotic platform. Two surgeons performed Anderson-Hynes dismembered pyeloplasty in 85 cases and YV-plasty in 5 cases. Five patients had RAP for secondary UPJO after failure of other treatments. Diuretic renography was performed at 6 weeks, and 6, 12, 18, 24, and 36 months postpyeloplasty. The mean follow-up was 14.1 ± 8.5 months. RESULTS The mean operative time was 167.7 ± 43.2 minutes, and the mean anastomotic time was 41.9 ± 14.1 minutes. The mean operative duration significantly decreased with time (P < 0.05). Ten patients needed simultaneous nephroscopic stone management via the pyelotomy incision. The mean blood loss was 56.6 ± 55.4 mL, and the mean hospital stay was 2.5 ± 0.5 days. There were five major postoperative (stent migration, urinoma) and three minor complications that were associated with the RAP procedures. Postoperative renal scintigraphy demonstrated only four cases with persistent obstruction. Eighty-three (94.3%) patients experienced improvement of symptoms whereas 5 continued to be symptomatic. Two patients needed secondary procedures to relieve persisting obstruction. There were no statistical differences in outcomes between the experienced surgeons and trainees (P = 0.28). CONCLUSIONS In the first large case series of RAP from Canada, we demonstrate that RAP can be performed with relatively short operative times and is safe and effective, achieving similar long-term results with standard open repair. We show that robot-assisted surgery can be safely transitioned to surgical trainees. With its cost and availability, its role in the Canadian system needs further study.
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Affiliation(s)
- Petar Erdeljan
- Division of Urology, Department of Surgery, The University of Western Ontario, London, Ontario, Canada
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Cestari A, Buffi NM, Lista G, Sangalli M, Scapaticci E, Fabbri F, Lazzeri M, Rigatti P, Guazzoni G. Retroperitoneal and Transperitoneal Robot-Assisted Pyeloplasty in Adults: Techniques and Results. Eur Urol 2010; 58:711-8. [DOI: 10.1016/j.eururo.2010.07.020] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2010] [Accepted: 07/13/2010] [Indexed: 11/29/2022]
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Freilich DA, Penna FJ, Nelson CP, Retik AB, Nguyen HT. Parental Satisfaction After Open Versus Robot Assisted Laparoscopic Pyeloplasty: Results From Modified Glasgow Children's Benefit Inventory Survey. J Urol 2010; 183:704-8. [DOI: 10.1016/j.juro.2009.10.040] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2009] [Indexed: 11/25/2022]
Affiliation(s)
- Drew A. Freilich
- Robotic Surgery, Research and Training Center, Department of Urology, Children's Hospital, Boston, Massachusetts
| | - Frank J. Penna
- Robotic Surgery, Research and Training Center, Department of Urology, Children's Hospital, Boston, Massachusetts
| | - Caleb P. Nelson
- Robotic Surgery, Research and Training Center, Department of Urology, Children's Hospital, Boston, Massachusetts
| | - Alan B. Retik
- Robotic Surgery, Research and Training Center, Department of Urology, Children's Hospital, Boston, Massachusetts
| | - Hiep T. Nguyen
- Robotic Surgery, Research and Training Center, Department of Urology, Children's Hospital, Boston, Massachusetts
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Papalia R, Simone G, Leonardo C, Guaglianone S, Forestiere E, Buscarini M, Gallucci M. Retrograde Placement of Ureteral Stent and Ureteropelvic Anastomosis with Two Running Sutures in Transperitoneal Laparoscopic Pyeloplasty: Tips of Success in Our Learning Curve. J Endourol 2009; 23:847-52. [DOI: 10.1089/end.2008.0617] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Rocco Papalia
- Regina Elena National Cancer Institute, Rome, Italy
- Campus Bio-Medico University of Rome, Rome, Italy
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Stravodimos KG, Anastasiou I, Adamakis I, Kapetanakis T, Koritsiadis G, Constantinides C. Laparoscopic pyeloplasty for ureteropelvic junction obstruction of the lower moiety in a completely duplicated collecting system: a case report. J Med Case Rep 2008; 2:333. [PMID: 18945370 PMCID: PMC2579304 DOI: 10.1186/1752-1947-2-333] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2008] [Accepted: 10/22/2008] [Indexed: 11/13/2022] Open
Abstract
Introduction There are only a few reports on laparoscopic pyeloplasty in kidney abnormalities and only one case for laparoscopic pyeloplasty in a duplicated system. Increasing experience in laparoscopic techniques allows proper treatment of such anomalies. However, its feasibility in difficult cases with altered kidney anatomy such as that of duplicated renal pelvis still needs to be addressed. Case presentation We present a case of a 22-year-old white Caucasian female patient with ureteropelvic junction obstruction of the lower ureter of a completely duplicated system that was managed with laparoscopic pyeloplasty. Crossing vessels were identified and transposed. The procedure was carried out successfully and the patient's symptoms subsided. Follow-up studies demonstrated complete resolution of the obstruction. Conclusion Since laparoscopic pyeloplasty is still an evolving procedure, its feasibility in complex cases of kidney anatomic abnormalities is herein further justified.
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Kaouk JH, Hafron J, Parekattil S, Moinzadeh A, Stein R, Gill IS, Hegarty N. Is Retroperitoneal Approach Feasible for Robotic Dismembered Pyeloplasty: Initial Experience and Long-Term Results. J Endourol 2008; 22:2153-9. [DOI: 10.1089/end.2008.0130] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Jihad H. Kaouk
- Section of Laparoscopic and Robotic Surgery, Glickman Urologic and Kidney Institute, Cleveland Clinic, Cleveland, Ohio
| | - Jason Hafron
- Section of Laparoscopic and Robotic Surgery, Glickman Urologic and Kidney Institute, Cleveland Clinic, Cleveland, Ohio
| | - Sijo Parekattil
- Section of Laparoscopic and Robotic Surgery, Glickman Urologic and Kidney Institute, Cleveland Clinic, Cleveland, Ohio
| | - Alireza Moinzadeh
- Section of Laparoscopic and Robotic Surgery, Glickman Urologic and Kidney Institute, Cleveland Clinic, Cleveland, Ohio
| | - Robert Stein
- Section of Laparoscopic and Robotic Surgery, Glickman Urologic and Kidney Institute, Cleveland Clinic, Cleveland, Ohio
| | - Inderbir S. Gill
- Section of Laparoscopic and Robotic Surgery, Glickman Urologic and Kidney Institute, Cleveland Clinic, Cleveland, Ohio
| | - Nicholas Hegarty
- Section of Laparoscopic and Robotic Surgery, Glickman Urologic and Kidney Institute, Cleveland Clinic, Cleveland, Ohio
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Sauer B, Flocquet M, Batch T, Blum A, Hubert J. Vascular renal anatomy and the ureteropelvic junction: preoperative multidetector CT scanning with split-bolus injection as a predictor of laparoscopic findings. J Endourol 2008; 22:13-8. [PMID: 18315471 DOI: 10.1089/end.2006.9857] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE To compare multidetector CT scan (MDCT) results with intraoperative findings in the detection of an inferior-pole pedicle crossing the ureteropelvic junction. PATIENTS AND METHODS Over the 2-year study period, 35 patients receiving laparoscopic pyeloplasty underwent preoperative investigation with a novel MDCT protocol in order to detect crossing vessels. Postprocessing, including maximum intensity projection, volume-rendering technique, and multiplanar reconstruction, was used in addition to standard axial views. RESULTS All the arteries found during laparoscopic surgery were detected by MDCT, but one radiologic false-positive was noted at the beginning of the series. Seven veins were not detected with MDCT. In the only case featuring an isolated inferior-pole vein, the aberrant vessel was identified by MDCT. CONCLUSION Multidetector CT scanning is a highly accurate way of providing all the information necessary preoperatively concerning renal parenchymal anomalies, urinary stones, and collecting system and vessel anatomy. It helps physicians make appropriate therapeutic decisions and gives surgeons information about what they can expect during laparoscopic procedures.
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Affiliation(s)
- Benoit Sauer
- Service d'Imagerie Guilloz, Hôpital Central, Avenue de Lattre de Tassigny, CHU Nancy, France.
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Wang L, Qin W, Tian F, Zhang G, Yuan J, Wang H. Cytokine responses following laparoscopic or open pyeloplasty in children. Surg Endosc 2008; 23:544-9. [DOI: 10.1007/s00464-008-9859-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2007] [Revised: 12/03/2007] [Accepted: 01/24/2008] [Indexed: 11/28/2022]
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Ramachandran A, Kurien A, Patil P, Symons S, Ganpule A, Muthu V, Desai M. A Novel Training Model for Laparoscopic Pyeloplasty Using Chicken Crop. J Endourol 2008; 22:725-8. [PMID: 18419217 DOI: 10.1089/end.2007.0380] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Anil Ramachandran
- Department of Urology, Muljibhai Patel Urological Hospital, Nadiad, India
| | - Abraham Kurien
- Department of Urology, Muljibhai Patel Urological Hospital, Nadiad, India
| | - Pradip Patil
- Department of Urology, Muljibhai Patel Urological Hospital, Nadiad, India
| | - Stephanie Symons
- Department of Urology, Muljibhai Patel Urological Hospital, Nadiad, India
| | - Arvind Ganpule
- Department of Urology, Muljibhai Patel Urological Hospital, Nadiad, India
| | - Veeramani Muthu
- Department of Urology, Muljibhai Patel Urological Hospital, Nadiad, India
| | - Mahesh Desai
- Department of Urology, Muljibhai Patel Urological Hospital, Nadiad, India
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Patel VR, Patil NN, Coughlin G, Dangle PP, Palmer K. Robot-assisted laparoscopic pyeloplasty: a review of minimally invasive treatment options for ureteropelvic junction obstruction. J Robot Surg 2008; 1:247-52. [PMID: 25484972 PMCID: PMC4247458 DOI: 10.1007/s11701-007-0065-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2007] [Accepted: 08/19/2007] [Indexed: 11/28/2022]
Abstract
Our aim was to examine the current status of minimally invasive approaches to ureteropelvic junction (UPJ) obstruction and compare it to the gold standard of open pyeloplasty. A review of the literature was conducted using PubMed and Medline databases for UPJ obstruction. Open pyeloplasty achieves good results, in the range of 90-100%. Laparoscopic pyeloplasty results are as good as those of open surgery. However, the goal of laparoscopic pyeloplasty as a means of providing minimally invasive surgery to a larger number of patients has not been achieved. The reason for this is the difficulty faced by most urologists in acquiring the technical skills to perform a laparoscopic pyeloplasty. In reports of robot-assisted pyeloplasty, results in the range of 88-97% appear to be achieved. Robotic technology has the potential to make minimally invasive pyeloplasty an easier skill to acquire for a larger number of urologists. Long-term data are still required to determine its efficacy.
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Porpiglia F, Billia M, Volpe A, Morra I, Scarpa RM. Transperitoneal left laparoscopic pyeloplasty with transmesocolic access to the pelvi-ureteric junction: technique description and results with a minimum follow-up of 1 year. BJU Int 2007; 101:1024-8. [DOI: 10.1111/j.1464-410x.2007.07323.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Brito AH, Mitre AI, Srougi M. Laparoscopic Pyeloplasty in Secondary Obstruction. J Endourol 2007; 21:1481-4. [DOI: 10.1089/end.2007.0082] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
| | - Anuar Ibrahim Mitre
- Division of Urology, University of São Paulo Medical School, São Paulo, Brazil
| | - Miguel Srougi
- Division of Urology, University of São Paulo Medical School, São Paulo, Brazil
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Castillo OA, Vitagliano G, Alvarez JM, Pinto I, Toblli J. Transmesocolic Pyeloplasty: Experience of a Single Center. J Endourol 2007; 21:415-8. [PMID: 17451334 DOI: 10.1089/end.2006.0202] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE We present our experience with dismembered left-sided pyeloplasty using a transmesocolic technique as a way to reduce operative time and facilitate repair by avoiding colon displacement. PATIENTS AND METHODS Between January 2004 and January 2006, a total of 11 transmesocolic laparoscopic pyeloplasties were performed by the same surgeon at our institution. The mean patient age was 41.6 years (range 14-65 years). Operative records and follow-up were reviewed. RESULTS A dismembered Anderson-Hynes pyeloplasty was carried out in nine patients (82%), while a Y-V plasty (9%) and a Fengerplasty (9%) were done in one patient each. Crossing vessels were observed in 8 patients (73%). A ureteral stent was left in all patients. The mean operative time was 88.6 minutes (range 60-125 minutes), and blood loss was minimal. Compared with classic transperitoneal laparoscopic left pyeloplasties, transmesocolic cases showed a significant reduction in operative time (88.6 minutes v 117 minutes; P < 0.05). There were no intraoperative complications or open conversions. The mean hospital stay was 2.1 days (range 2-3 days). Only 1 patient (9%) demonstrated narrowing of the anastomosis, which occurred 12 months after a Fengerplasty. CONCLUSIONS The transmesocolic approach to a dilated left pelvis enables a shorter operative time without increasing morbidity. More patients and longer follow-up are necessary to determine its effect on convalescence.
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Affiliation(s)
- Octavio A Castillo
- Section of Endourology and Laparoscopic Urology, Department of Urology, Clínica Santa Maria, Santiago de Chile, Chile
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Shah KK, Louie M, Thaly RK, Patel VR. Robot Assisted Laparoscopic Pyeloplasty: a review of the current status. Int J Med Robot 2007; 3:35-40. [PMID: 17441024 DOI: 10.1002/rcs.122] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Over the last decade minimally invasive endourologic and laparoscopic techniques have become the first line therapies for primary UPJ obstruction. Robotic assisted laparoscopic pyeloplasty for the correction of ureteropelvic junction has achieved outcomes comparable to those of open and laparoscopic techniques. We present a comprehensive review of the current literature of robotic assisted pyeloplasty. METHODS We performed a systemic review of all the current literature examining demographic data, intra operative parameters and post-operative outcomes. RESULTS In most published series in the literature, the operative time ranges from 122 to 300 minutes and the operative time ranges from 27 to 77 ml. Most series considers subjective improvement in the symptoms and improved drainage on post-operative diuretic renal scan as the measures of success. The reported success rates vary from 89 to 100%. CONCLUSION Robotic pyeloplasty is a feasible alternative to laparoscopic pyeloplasty. Short-term results indicate equivalent outcomes with the laparoscopic procedure. Long-term studies are still needed to compare robotic and open pyeloplasty outcomes, and to define the role of robotic pyeloplasty in a cost prohibitive health care system.
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Affiliation(s)
- Ketul K Shah
- The Ohio State University Medical Centre, Department of Robotics and Computer Assisted Surgery, Division of Urology, Columbus, OH 43210, USA.
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Kawa G, Tatsumi M, Hiura Y, Muguruma K, Kinoshita H, Matsuda T. Retroperitoneoscopic pyeloplasty: Using reconstructive methods based on intraoperative findings. Int J Urol 2006; 13:1171-4. [PMID: 16984547 DOI: 10.1111/j.1442-2042.2006.01530.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
AIM Reconstructive laparoscopic procedures have been recognized as a less invasive treatment than conventional open procedures. However, although the laparoscopic pyeloplasty has also been accepted as useful, few findings have been reported relevant to the retroperitoneal approach. To elucidate its effectiveness and safety, laparoscopic surgery via the retroperitoneal approach was examined in our institution. Furthermore, the importance of laparoscopic observation for ureteropelvic junction and urine passage ureteropelvic junction without indwelling ureteral stent. METHODS Between July 1998 and December 2004, 13 men and 15 women underwent laparoscopic retroperitoneal surgery for ureteropelvic junction obstruction. The mean patient age was 33.6 years (range: 13-70 years). Methods of repair were determined by intraoperative findings for the relationship between the ureteropelvic junction and surrounding vessels. An indwelling ureteral stent was removed before initiating laparoscopic operation to observe the relationship between ureteropelvic junction and aberrant vessels more precisely. RESULTS An aberrant renal vessel was found in 13 patients (46%). Dismembered pyeloplasty was carried out in 21 patients, Y-V plasty in five patients and Hellstrom technique in two patients. Ureteral transposition was not required in dismembered pyeloplasty cases. All patients achieved retroperitoneoscopic pyeloplasty without open conversion. The mean operative time was 272 min (range: 155-490 min). The mean estimated blood loss was 44 mL (range: 10-200 mL). No major complications were observed during the intraoperative period, but urinary tract infection occurred in two patients in the postoperative period. In all patients except one, obstruction was improved or resolved. CONCLUSIONS Laparoscopic retroperitoneal surgery is not only able to repair ureteropelvic junction obstruction, but can also be done safety and less invasively. We believe that laparoscopic observation without indwelling stent will contribute to a more appropriate choice of pyeloplasty.
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Affiliation(s)
- Gen Kawa
- Department of Urology and Andrology, Kansai Medical University, Moriguchi city, Osaka, Japan.
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Bachmann A, Ruszat R, Forster T, Eberli D, Zimmermann M, Müller A, Gasser TC, Sulser T, Wyler S. Retroperitoneoscopic Pyeloplasty for Ureteropelvic Junction Obstruction (UPJO): Solving the Technical Difficulties. Eur Urol 2006; 49:264-72. [PMID: 16439056 DOI: 10.1016/j.eururo.2005.12.036] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2005] [Revised: 12/05/2005] [Accepted: 12/07/2005] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To evaluate our current practice in retroperitoneoscopic pyeloplasty in patients with ureteropelvic junction obstruction (UPJO). Special interest was paid to technical difficulties associated with the retroperitoneoscopic approach. METHODS Our retroperitoneoscopic approach for pyeloplasty is explained step for step including the most technically challenging part: the ureteropelvic anastomosis. RESULTS Within 49 months a total of 47 retroperitoneoscopic pyeloplasties we performed at our institution. Before pyeloplasty an endopyelotomy had failed in five patients (11%). We did not necessarily perform a ventral transposition of the anastomosis in cases with a crossing vessel. Two (4%) conversions to open surgery were required because of scarring after previous endopyelotomy and massive obesity resulting in a limited working space. There were no intraoperative complications. A recurrence of UPJO was observed in 2% (n = 1). CONCLUSION Functional results after retroperitoneoscopic pyeloplasty are excellent and comparable to those of open surgery. However, special knowledge of retroperitoneoscopy is necessary to provide the patient with a safe and effective minimally invasive alternative to open pyeloplasty.
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Affiliation(s)
- A Bachmann
- Department of Urology, University Hospital Basel, Basel, Switzerland.
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