Feasibility and Safety of Retroperitoneal Laparoendoscopic Single-Site Dismembered Pyeloplasty: A Clinical Report of 10 Cases

Long-term outcome of retroperitoneoscopic one-trocar-assisted pyeloplasty: a single-center and single-surgeon experience

PURPOSE

The aim of this study was to assess the long-term outcomes of retroperitoneoscopic one-trocar-assisted pyeloplasty (OTAP) for ureteropelvic junction obstruction (UPJO) in children.

METHODS

This retrospective analysis included 70 pediatric cases, all under the age of 5, diagnosed with UPJO and treated with the OTAP technique between May 2011 and June 2013 by a single surgeon. A single 10 mm operative scope with a 5 mm working channel was utilized to mobilize the ureteropelvic junction (UPJ) and exteriorize it through the trocar insertion site. Subsequently, conventional Anderson-Hynes dismembered pyeloplasty was conducted extracorporeally. Patient's demographics, operative time, hospital stay, complications, and success rate were evaluated.

RESULTS

Seventy pediatric patients (65 males and 5 females) underwent OTAP, with ages at the time of operation ranging from 1 month to 5 years (mean = 22.6 ± 18.6 months). The mean operative time was 74.8 ± 15.2 min. There was a significant reduction in the mean renal pelvis size from 34.3 ± 8.1 mm preoperatively to 13.8 ± 4.7 mm postoperatively (p < 0.05). Moreover, the mean differential renal function (DRF) increased from 47.9 ± 9.8% preoperatively to 51.2 ± 5.9% postoperatively (p < 0.05). All patients experienced an uneventful postoperative recovery, with a median hospital stay of 3.4 days. The success rate was 95.7%, with a median follow-up time of 75 months (range: 6-125 months).

CONCLUSION

OTAP is a safe and feasible minimally invasive technique to correct ureteropelvic junction obstruction in children. It could be considered as a treatment of choice for children under the age of 5 as it combines the advantages of open and retroperitoneoscopic pyeloplasty and presents excellent long-term outcomes.

TRIAL REGISTRATION NUMBER

NCT06349161 April 4th, 2024, retrospectively registered.

Comparative study of different surgical approaches for treatment of UPJ obstruction according to the degree/severity of hydronephrosis factor

OBJECTIVE

To compare the efficacy of two different surgical approaches during and after pyeloplasty according to the degree/severity of hydronephrosis factor.

MATERIALS AND METHODS

Sixty child patients with UPJ obstruction admitted to our hospital from August 2019 to October 2021 were collected. Patients who underwent retroperitoneal laparoscopic pyeloplasty (RPLP) were enrolled into Group A (n = 20), while those who received transperitoneal laparoscopic pyeloplasty (TLP) were selected as Group B (n = 40). Clinical parameters, including gender, age, laterality of UPJ obstruction, degree/severity of hydronephrosis, body weight, operation time, drainage tube indwelling time, complete oral feeding time, and length of hospital stay, were compared between the two groups.

RESULTS

All 60 child patients were operated upon successfully without conversion to open surgery. There were no statistically significant differences in gender, age, laterality of UPJ obstruction, and body weight between the two groups, while the operation time of TLP was shorter than that of RPLP, indicating a statistically significant difference (P < 0.001). The differences in complete oral feeding time, drainage tube indwelling time, and length of hospital stay were statistically significant between the two groups, and RPLP was superior to TLP in terms of postoperative recovery time (P < 0.001). A stratified comparison showed that there were no statistically significant differences in anteroposterior diameter ≤ 20 mm, while there were statistically significant differences in anteroposterior diameter >20 mm. Hydronephrosis is reviewed after 3 months of the operation, degree/severity of hydronephrosis have been reduced.

CONCLUSION

Both RPLP and TLP are safe and feasible in the treatment of UPJ obstruction, and their overall surgical effects are equivalent. For child patients with anteroposterior diameter ≤ 20 mm, RPLP is available, while patients with anteroposterior diameter >20 mm, TLP is recommended.

Retroperitoneal laparoendoscopic single-site approach for renal cyst decortication - first experience and a review of literature

Laparoendoscopic single-site (LESS) approach has been successfully employed for a number of urologic procedures. The retroperitoneal approach further limits the working space and instrument movement during LESS surgery, but has the advantage of a faster post-operative recovery and lower complications rate. We present our first experience using retroperitoneal LESS approach for a renal cyst decortication in a 40-year-old patient. The operative time was 40 minutes, the blood loss was minimal and we did not encounter significant conflicts between the instruments. The patient was discharged 2 days after the procedure and returned to full normal activity within one week. We consider that the retroperitoneal LESS approach is feasible for upper tract urologic surgery. Pre-bent instruments might further improve surgical gestures and extend the indications for more complex procedures. Nevertheless, the advent of reusable devices is expected to increase the cost-effectiveness of LESS and expand its use.

Laparoendoscopic single site surgery versus conventional laparoscopy for transperitoneal pyeloplasty: A systematic review and meta-analysis

We aimed to review studies comparing the outcomes of the laparoendoscopic single site (LESS) pyeloplasty with those of conventional laparoscopic pyeloplasty (CLP). A systematic review of the literature was performed according to the PRISMA (preferred reporting items for systematic reviews and meta-analysis) criteria. The methodological quality of the studies was rated according validated scales. The level of evidence (LE) was reported as described by the Oxford criteria. Preoperative demographic parameters and perioperative outcomes between the two surgical techniques were assessed. A meta-analysis of the included studies was performed. A total of 5 studies were elected for the analysis, including 164 cases, 70 (42.6%) of them being LESS and 94 (57.4%) being CLP. Four studies were observational retrospective comparative studies (LE: 3a-4); one was a prospective randomized controlled trial (LE: 2b). There was no significant difference in age, body mass index, gender, side and presence of the crossing vessel, between the groups. There was no significant difference regarding the operative time (weight mean difference [WMD]: −7.02; 95% confidence interval [CI]: −71.82–57.79; P = 0.83) and length of hospital stay (WMD: 0.04; 95% CI: −0.11–0.20; P = 0.58), whereas the estimated blood loss was statistically lower for LESS (WMD: −16.83; 95% CI: −31.79–−1.87; P = 0.03). The postoperative use of analgesic favored the LESS group but without reaching statistical significance (WMD: −7.52; 95% CI: −17.56–2.53; P = 0.14). In conclusion, LESS pyeloplasty offers comparable surgical and functional outcomes to CLP while providing the potential advantages of less blood loss and lower analgesic requirement. Thus, despite being more technically challenging, LESS pyeloplasty can be regarded as a minimally invasive approach for patients seeking fewer incisional scars.

Retroperitoneal laparoscopic management of ureteropelvic junction obstruction in patients with horseshoe kidney

OBJECTIVE

To report our experience with retroperitoneal laparoscopic pyeloplasty for the management of ureteropelvic junction (UPJ) obstruction in patients with horseshoe kidneys (HSKs).

MATERIALS AND METHODS

Between March 2005 and May 2012, 2 boys, 5 men, and 1 woman (mean age, 23.9 years; range, 7-42 years) with HSKs underwent retroperitoneal laparoscopic dismembered pyeloplasties for UPJ obstructions with transections of the isthmuses. One patient had a renal calculus that was extracted during surgery. The follow-up included clinical evaluations, ultrasonography, intravenous urography, and diuretic renography.

RESULTS

Retroperitoneal laparoscopic dismembered pyeloplasty was feasible in all cases. The median operative time was 192 minutes (range, 148-252 minutes), and there were no perioperative complications. The mean hospital stay was 5.8 days (range, 4-7 days). The mean follow-up time was 45 months (range, 18-96 months). All patients were asymptomatic and exhibited decreased pelvic dilation at follow-up.

CONCLUSION

The retroperitoneal laparoscopic approach is feasible and safe for pyeloplasty in UPJ obstruction associated with HSK. Isthmectomy and a fully mobilized kidney offer better surgical exposure during the operation.

Laparoendoscopic single-site ureteroureterostomy with intraoperative retrograde ureteroscopy-assisted technique for benign proximal and middle ureteral strictures: a single-center experience

OBJECTIVE

To report a minimally invasive and reproducible technique that greatly facilitates the identification of the stricture during laparoendoscopic single-site ureteroureterostomy (LESS-UU) for benign proximal and middle ureteral strictures, using the intraoperative retrograde ureteroscopy-assisted technique.

PATIENTS AND METHODS

Between April 2011 and January 2013, 13 patients with a benign proximal or middle ureteral stricture underwent LESS-UU at our institution. A combination of diuretic renal scans, antegrade/retrograde ureteropyelography and/or computed tomography, and stent placement or exchange was preoperatively performed to assess all patients. The intraoperative retrograde ureteroscopy-assisted technique was used to identify the exact position of the stricture and place the stenting during LESS-UU.

RESULTS

Intraoperative retrograde ureteroscopy was successfully performed in all cases. The mean operative time was 156 minutes (range, 125-190 minutes), and the estimated blood loss was 80 mL (range, 20-160 mL). The mean hospital stay was 5 days (range, 4-7 days). One patient required conversion to open surgery because of the severe adhesions surrounding the stricture that resulted in failure to progress. Urine leakage occurred in 1 patient postoperatively and was successfully treated by conservative management. Postoperative fever occurred in another patient, who was treated with a dose of oral antibiotics. No major intraoperative or postoperative complication occurred. Clinical and radiographic success was achieved in 100% (13/13) of patients during a mean follow-up of 13.1 months (range, 9-27 months).

CONCLUSIONS

LESS-UU is feasible and safe for repairing benign proximal and middle ureteral stricture. The intraoperative retrograde ureteroscopy-assisted technique during LESS-UU is useful for localizing the stricture.