Single-Incision Pyeloplasty—As Feasible As Laparoscopic Pyeloplasty? Results of the Initial Nine Cases

Abstract

Introduction: Ureteropelvic junction (UPJ) obstruction, mainly due to primarily obstructed UPJ or compression related to crossing vessels, is the main indication for pyeloplasty. Laparoscopic pyeloplasty was introduced to reduce the perioperative morbidity and to improve cosmesis of open procedures and is widely accepted as operative standard in experienced urologic centers.1–3 In this video, we present a single-incision pyeloplasty (SIP) in the single-incision triangulated umbilical surgery (SITUS) technique, using straight optics and instruments in triangulation.4,5 Moreover, we present the initial series of nine consecutive patients treated by SIP in the SITUS technique from October 2009 to November 2011. Materials and Methods: In the video, we present a 17-year-old male patient with right UPJ obstruction due to a crossing vessel, which underwent SIP. The umbilicus was incised at 3/4 of its circumference, pneumoperitoneum was achieved by the Verres technique, and a 5-mm camera trocar was placed. Two 5-mm working trocars (Versaport, Covidien) were placed with a distance of 5–6 cm, allowing triangulation. Using conventional laparoscopic instruments, the colon was mobilized; the ureter, renal pelvis, and renal vessels were dissected. The UPJ was excised, a 7-French ureteral stent was placed, and realignment was performed by a bilateral barbed running suture (Quill SRS PDO 3-0; Angiotech).6 Anastomosis was secured by a 2-ml fibrin glue (Tissucol; Baxter). Results: Five male and four female patients underwent surgery. The median body mass index was 23.7 (20.4; 30.3) and the body height was 173 cm (164; 188). Four patients had right and five left UPG obstructions. Three cases had previous abdominal surgery, before surgery, the UPG obstruction was verified by isotope nephrography in all cases. All procedures were performed successfully. The intraoperative blood loss was <100 cc, the median OR time 143 (110; 176) minutes, respectively. The UPJ obstruction was caused by crossing vessels in six cases, by intrinsic obstructions in two cases, and by previous endopyelotomy in one case. Neither wound infections nor umbilical skin ischemias were observed. In general, the ureteral stents were extracted 3 weeks after surgery. A sufficient drainage of the renal pelvis after 3 or 4 months was documented for all cases by isotope nephrography. Conclusion: SIP is an attractive alternative to laparoscopic pyeloplasty for experienced laparoscopic surgeons. This single-incision procedure might improve the cosmetic outcome as well as the perioperative morbidity, but further studies has to be conducted, to approve these assumption. No competing financial interests exist. Runtime of video: 9 mins 6 secs