Retrograde Placement of Ureteral Stent and Ureteropelvic Anastomosis with Two Running Sutures in Transperitoneal Laparoscopic Pyeloplasty: Tips of Success in Our Learning Curve

Abstract

We report our experience of transperitoneal laparoscopic dismembered pyeloplasties describing our step-by-step surgical technique, and we retrospectively analyze the impact on operative times of technical modifications that were introduced during the learning curve. From November 2002 to May 2008, 84 consecutive patients with ureteropelvic junction (UPJ) obstruction were selected for laparoscopic pyeloplasty (LP). The main steps of the surgical procedure are described. In the initial 14 patients who underwent LP, we performed intraoperative antegrade stenting, and we configured the ureteropelvic anastomosis with interrupted sutures; in the 25 following patients, anastomosis was performed with running sutures. In the latest 45 patients, the ureteral stent was positioned retrograde, and ureteropelvic anastomosis was performed with two running sutures. We evaluated the impact of technical modifications on the operative times, dividing patients into three groups (group A, first 14 patients; group B, following 25 patients; and group C, last 45 patients). Median operative times of each group were compared with the Student t test. No major complications occurred, while postoperative urinary leakage was seen in three patients at bladder catheter removal (two in group A and one in group B). Mean operative blood loss was 70 mL, and mean hospital stay was 1.6 days. Median operative time was 115 min (range 110-125 min) for group A, 100 min (range 95-115 min) for group B, and 85 min (range 65-95 min) for group C; differences between operative times of groups A and B and between groups B and C were statistically significant (both P < 0.001). At a median follow-up of 38 months, recurrent symptoms developed in three patients. Overall, the success rate of the procedure was 96.5%. In a retrospective analysis of our series, the retrograde placement of the ureteral stent and the ureteropelvic anastomosis with two running sutures seemed to be tips of success in reducing operative times.