Laparoendoscopic Single-site Pyeloplasty Research Articles

Comparison of the initial operative experience of a single surgeon carrying out robot-assisted laparoscopic pyeloplasty, laparoendoscopic single-site pyeloplasty and conventional laparoscopic pyeloplasty.

Comparison of the initial operative experience of a single surgeon carrying out robot-assisted laparoscopic pyeloplasty, laparoendoscopic single-site pyeloplasty and conventional laparoscopic pyeloplasty.

Hybrid laparoendoscopic single-site (LESS) pyeloplasty: Initial experience in children

Mini-invasive surgery is still evolving to get better surgical conditions for patients with ureteropelvic junction obstruction. We used technical modifications (hybrid pyeloplasty) that simplify surgical steps of laparoendoscopic single-site pyeloplasty in children. Our aim was to compare hybrid pyeloplasty to laparoendoscopic single-site pyeloplasty and to open pyeloplasty. We retrospectively reviewed records of patients with ureteropelvic junction obstruction aged<14years undergoing pyeloplasty at our institute from January 2011 to December 2015. Demographic data, laterality, operative time, length of hospital stay, drainage tubes, and postoperative complications were recorded. Surgical outcomes were evaluated based on renal sonography and Lasix diuretic renography. Among 38 patients, 17 underwent open pyeloplasty (group I), 10 had laparoendoscopic single-site pyeloplasty (group II) and 11 had hybrid pyeloplasty (group III). The mean age at the time of operation was 55 months. The operative time in group III was significantly shorter than that in group I and group II (P<0.001). The shortest median hospital stay was noted in the group III. The mean follow-up period was 26 months (range: 6-52 months). The hybrid pyeloplasty using LESS combine the successful outcomes of open surgery and advantages of minimally invasive surgery. It offers small incision surgery, good working space, short operation time, secure anastomosis and good cosmetic results. 5.

単孔式腹腔鏡下腎盂形成術は，腎盂尿管移行部通過障害の標準術式になりうるか？：単一施設で行われた3つの術式（開放腎盂形成術，腹腔鏡下腎盂形成術，単孔式腹腔鏡下腎盂形成術）の比較検討

単孔式腹腔鏡下腎盂形成術は，腎盂尿管移行部通過障害の標準術式になりうるか？：単一施設で行われた3つの術式（開放腎盂形成術，腹腔鏡下腎盂形成術，単孔式腹腔鏡下腎盂形成術）の比較検討

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.

Laparoendoscopic single‐site versus conventional laparoscopic pyeloplasty: A matched pair analysis

To compare the outcomes of laparoendoscopic single-site pyeloplasty versus those of conventional laparoscopic pyeloplasty. A total of 26 laparoendoscopic single-site pyeloplasty cases carried out in University Hospital: Kyoto Prefectural University of Medicine, Kyoto, Japan, from 2008 to 2013 were compared with a control group of 26 age-matched laparoscopic pyeloplasty cases carried out during the same study period. The mean age of the patients was 20.4 years (range 1-56 years). Laparoendoscopic single-site pyeloplasty was carried out on the right in nine cases and on the left in 17 cases. The operative time was 246 ± 68 min. Regarding the 14 pediatric patients, the mean age was 7.1 years (range 1-14 years). The operative time was 243 ± 49 min. As for the 12 adult patients, the mean age was 35.8 years (range 16-56 years). The operative time was 248 ± 86 min. The mean operative time of the control group in age-matched laparoscopic pyeloplasty was 239 ± 51 min. Times were 229 ± 54 min for the pediatric patients and 253 ± 45 min for the adult patients. There was no significant difference in the operative time between the control group and the laparoendoscopic single-site group for both adults and children. Blood loss was minimal, and no intraoperative and postoperative complications were observed in the 26 laparoendoscopic single-site pyeloplasty cases. The present findings suggest that laparoendoscopic single-site pyeloplasty can be used in both pediatric and adult patients, offering a superior cosmetic outcome than conventional laparoscopic pyeloplasty, and a lower degree of postoperative pain. A large-scale prospective, randomized study is required to confirm these findings, and to define the future role of laparoendoscopic single-site pyeloplasty.

Robotic-assisted laparoscopic approaches to the ureter: Pyeloplasty and ureteral reimplantation.

Introduction and Objectives:The benefits of robotic surgery when compared to standard laparoscopy have been well established, especially when it comes to reconstructive procedures. The application of robotic technology to laparoscopic pyeloplasty has reduced the steep learning curve associated with the procedure. Consequently, this has allowed surgeons who are less experienced with laparoscopy to offer this treatment to their patients, instead of referring them to centers of excellence. Robotic pyeloplasty has also proved useful for repairing secondary UPJO, a procedure which is considered extremely difficult using a conventional laparoscopic approach. Finally, the pursuit of scarless surgery has seen the development of laparoendoscopic single site (LESS) procedures. The application of robotics to LESS (R-LESS) has also reduced the difficulty in performing conventional LESS pyeloplasty. Herein we present a literature review with regards to robotic-assisted laparoscopic pyeloplasty. We also discuss the benefits of robotic surgery with regards to reconstruction of the lower urinary tract.Materials and Methods:A systematic literature review was performed using PubMed to identify relevant studies. There were no time restrictions applied to the search, but only studies in English were included. We utilized the following search terms: Ureteropelvic junction obstruction and laparoscopy; laparoscopic pyeloplasty; robotic pyeloplasty; robotic ureteric reimplantation; robotic ureteroneocystostomy; robotic boari flap; robotic psoas hitch.Results:There has been considerable experience in the literature with robotic pyeloplasty. Unfortunately, no prospective randomized studies have been conducted, however there are a number of meta analyses and systematic reviews. While there are no clear benefits when it comes to surgical and functional outcomes when compared to standard laparoscopic pyeloplasty, it is clear that robotics makes the operation easier to perform. There is also a benefit to the robotic approach when performing a redo-pyeloplasty. Robotic pyeloplasty has also been applied to the pediatric population, and there may be a benefit in older children while in very young patients, retroperitoneal open pyeloplasty is still the gold standard. In the field of single incision surgery R-LESS is technically easier to perform than conventional LESS. However, the design of the current robotic platform is not completely suited for this application, limiting its utility and often requiring a larger incision. Optimized R-LESS specific technology is awaited. What is clear, from a number of analyses, is that robotic pyeloplasty is considerably more expensive than the laparoscopic approach, largely due to costs of instrumentation and the capital expense of the robot. Until cheaper robotic technology is available, this technique will continue to be expensive, and a cost-benefit analysis must be undertaken by each hospital planning to undertake this surgery. Finally, the benefits of upper tract reconstruction apply equally to the lower tract although there is considerably less experience. However, there have been a number of studies demonstrating the technical feasibility of ureteral reimplantation.Conclusions:Robotic-assisted laparoscopic pyeloplasty is gaining popularity, likely due to the shorter learning curve, greater surgeon comfort, and easier intracorporeal suturing. This has allowed more surgeons to perform the procedure, improving accessibility. Robotic technology is also beneficial in the field of LESS. Nevertheless, the procedure still is not as cost-effective as the conventional laparoscopic approach, and until more affordable robotic technology is available, it will not be universally offered.

Laparoendoscopic single-site pyeloplasty for ureteropelvic junction obstruction

Laparoendoscopic single-site pyeloplasty for ureteropelvic junction obstruction

Laparoendoscopic Single-Site Pyelolithotomy in a Pediatric Patient

Introduction and Objectives: The preferred treatment for patients with a large stone burden is percutaneous nephrolithotomy (PCNL). Although it offers excellent stone clearance rates, PCNL access and treatment can be challenging, with considerable potential morbidity. In the modern era of routine minimally invasive surgery, we offer a novel, endourologic approach for patients with significant nephrolithiasis who otherwise may be offered only PCNL or an open procedure, both of which may confer greater morbidity. Laparoendoscopic single site (LESS) is an emerging surgical approach with limited data. To our knowledge, a pyelolithotomy using pure LESS has not been described in the literature. Methods: In the accompanying video, we present this novel surgical technique in a child with cystinuria, recurrent stones, and previous complicated contralateral PCNL. Based on our larger initial experience with LESS in children, we use a variety of access devices and working instruments. Here we use a SILS-port access device (Covidien®) with articulating instruments (graspers, cauterizing L-hook) and articulating camera (Olympus®). We feel these instruments offer improved ergonomics and provide higher degrees of freedom. Results: A double-J stent is initially placed and the bladder filled to distend the renal pelvis. The patient is placed in mild flank and a 1.5 cm skin incision is used with a 2.5 cm fascial incision to accommodate the single port device. Optimal positioning of the operating table, viewing screens, and surgical team is essential for LESS. The camera and instruments are best triangulated in the access port device, with the working instruments on the same horizontal plane and of different lengths, and the camera angled to limit instrument collision. We favor a transmesenteric approach when possible, to minimize mobilization of bowel. Unlike LESS pyeloplasty, minimal dissection is needed to expose the pelvis for eventual mini-pyelotomy and stone extraction. A hitch stitch is used to stabilize the pelvis and another is used to lift the mesenteric vessels to improve visualization and facilitate incision of the pelvis. The stones are removed and the pelvis is reapproximated. We use a standard approach to facilitate knot tying during LESS with a straight needle driver and articulating grasper. The pelvis is closed around a stent and the stones are placed in a bag for removal. Conclusions: LESS-P is a novel approach for the treatment of extensive nephrolithiasis and it supplements current surgical options. For experienced laparoscopists, it can be less morbid than traditional alternatives. It should be considered whenever PCNL is not feasible, scarless surgery is desired, radiation exposure should be limited, or when pyeloplasty is also indicated. No competing financial interests exist. Runtime of video: 5 mins 56 secs

IJU this issue

This issue deals with a wide range of clinical topics of urology, and contains one Review Article, 12 Original Articles, one Case Report and two Letters to the Editor. Urinary incontinence after radical prostatectomy is a big problem for patients with prostate cancer, and many urologists try to improve postoperative continent rates. Although recent systemic reviews and meta-analyses have shown that robot-assisted radical prostatectomy (RALP) has higher postoperative continence rates than retropubic radical prostatectomy (RRP) and laparoscopic radical prostatectomy (LRP), urinary incontinence has remained one of the most bothersome postoperative complications, even after RARP. The Review Article by Kojima et al. (Fukushima, Japan) showed that the basic concept of the intraoperative technique to improve postoperative urinary continence is to maintain as normal anatomical and functional structure in the pelvis as possible. They precisely reported three processes that consisted of preservation, reconstruction and reinforcement, helping us to modify our technique during RALP. Another topic regarding prostate cancer in this issue is pelvic lymph node dissection for prostate cancer. Mitsuzuka et al. (Sendai, Japan) investigated the role of pelvic lymph node dissection for low-risk prostate cancer using their medical records for 1268 patients undergoing open radical prostatectomy. Their conclusion is that pelvic lymph node dissection can be spared at radical prostatectomy for low-risk disease because of its poor diagnostic and therapeutic value, which is useful information when we carry out radical prostatectomy. Open versus laparoscopic, and partial versus radical nephrectomy (RN) for T1a renal cell carcinoma (RCC) are important topics, because the use of partial nephrectomy (PN) remains low in the community setting despite its established benefits. Bianchi et al. (Milan, Italy) examined the trends of open and laparoscopic PN and RN according to sociodemographic and tumor characteristics, using the USA Surveillance, Epidemiology, and End Results Medicare-linked database. They showed that older and female patients are less likely to undergo nephron-sparing surgery, and are more likely to have a radical nephrectomy by the laparoscopic approach instead, although utilization rates of PN are increasing. Further encouragement is required to increase PN for T1a RCC. Another topic regarding RCC in this issue is RCC extending into the inferior vena cava (IVC). Kondo et al. (Tokyo, Japan) investigated the impact of histological subtypes on the survival of patients presenting with RCC extending into the IVC, using their 68 cases who underwent RN and IVC thrombectomy. Their conclusion is that patients with RCC extending into the IVC with a papillary subtype show a considerably shorter survival compared with those with a clear cell subtype, which is helpful when we decide operative indications for patients with RCC extending into the IVC. Laparoendoscopic single site (LESS) surgery is a technical modification of conventional laparoscopy whereby the entire surgical procedure is carried out through a single abdominal wall incision. Tugcu et al. (Istanbul, Turkey) performed a prospective randomized study of LESS versus conventional transperitoneal laparoscopic pyeloplasty. A total of 39 patients were enrolled in their prospective study, and LESS pyeloplasty could offer faster recovery and higher patient satisfaction than conventional laparoscopic pyeloplasty. However, median operative time was longer in the LESS pyeloplasty group compared with the conventional laparoscopic group. Recently, a reduced port surgery using thin forceps, but not LESS, is increasing with technical advancements. In this sense, a comparison of reduced port pyeloplasty using thin forceps with LESS pyeloplasty would be interesting for evaluating the most minimally-invasive pyeloplasty. None declared.

Nephrolithotomy Performed Concurrently With Laparoendoscopic Single-site Pyeloplasty

The objective of the present study was to evaluate the results of laparoendoscopic single-site (LESS) pyeloplasty and pyelolithotomy, which were performed concurrently in patients with pelviureteric junction obstruction (PUJO) and renal stones. Four patients with PUJO and renal stones underwent pyelolithotomy performed concurrently with LESS pyeloplasty. In 3 patients, a 2.5-cm incision was made in the umbilical region. In the fourth patient, the 2.5-cm vertical incision was made at a site 7cm below the umbilical region because of a stone in the right lower calyx. After dissection of the pelviureteric junction, an incision of approximately 1cm was made along the presumed transection line of the renal pelvis. The pyelolithotomy was performed using a 24F rigid nephroscope through a SILS port. Dismembered pyeloplasty was performed after extraction of the renal stones was completed. The mean operation time was 277minutes (range, 225-373), and the mean lithotomy time was 31minutes (range, 20-50). No intraoperative or postoperative complications were observed. For all 4 patients, discharge from the hospital was possible after a mean of 3.4 postoperative days (range, 3-4). All patients became stone free. Postoperative ultrasound revealed that hydronephrosis improved in all patients. In all patients, resolution of the symptoms was confirmed. LESS nephrolithotomy with pyeloplasty is a safe and effective procedure with a good cosmetic result for patients with PUJO and renal stones.

Robot-Assisted Transumbilical Laparoendoscopic Single-Site Pyeloplasty: Technique and Perioperative Outcomes from a Single Institution

Transumbilical laparoendoscopic single-site (U-LESS) pyeloplasty may provide improved cosmesis compared with conventional laparoscopic pyeloplasty. However, U-LESS pyeloplasty can be challenging because of the need for extensive suturing. The wristed instrumentation of robot-assisted laparoendoscopic single-site (R-LESS) pyeloplasty provides improved dexterity to facilitate intracorporeal suturing. We therefore present our technique and experience with R-LESS pyeloplasty for ureteropelvic junction obstruction (UPJO). The da Vinci(®) S or Si Surgical System (Intuitive Surgical, Sunnyvale, CA) was used in all cases. Ureteral stents were placed cystoscopically at the start of each case. A 3-cm skin incision was made adjacent to the umbilicus. Three ports (12 mm, 8 mm, and 5 mm) were placed either through separate fascial incisions or into a GelPort(®) (Applied Medical, Rancho Santa Margarita, CA). Key techniques included port staggering, a "chopstick" arrangement of the instruments, and use of a 30° lens in an upward configuration. Traditional dismembered pyeloplasty procedures were performed in all cases. Patients less than 45 years of age with no prior abdominal surgery were offered this approach. Eight patients (4 female; 5 right-sided; median age, 22 years) underwent R-LESS pyeloplasty without the need for additional ports. All patients were discharged by the third postoperative day, and 5 were discharged on Day 1. One patient experienced urine leakage, which was managed with a temporary nephrostomy tube. Length of follow-up ranged from 29 to 46 months. No patients have developed symptoms or radiographic evidence of recurrent UPJO. R-LESS pyeloplasty can be safely performed for selected patients with currently available robotic equipment. Careful patient selection and case setup are key to successfully performing these procedures.

Laparoendoscopic Single-site Pyeloplasty: Outcomes of an International Multi-institutional Study of 140 Patients

To report an international, multi-institutional series of laparoendoscopic single-site pyeloplasty (LESS-P) with analysis of functional outcomes. LESS-P cases performed between October 2007 and June 2012 at 7 institutions worldwide per individual institutional protocols, entry criteria, and techniques were included. Patient characteristics, operative indications, perioperative outcomes, and postoperative follow-up were retrospectively collected and analyzed. The study included 140 adult patients (age 39.9 ± 15.7 years; body mass index 24.8 ± 4.2 kg/m(2); 15% with previous abdominal surgery) who underwent unilateral LESS-P, most of whom (94.3%) had dismembered reconstructions. Mean operative time was 202.1 ± 47 minutes with an estimated blood loss of 61.2 ± 44.6 mL. Robotic laparoendoscopic single-site surgery was applied in 31 patients (22.1%). A single 2-3 mm accessory port was used in 44 patients (31.4%) and a single 5-12 mm accessory port was added in 9 patients (6.4%), whereas 10 patients (7.1%) were converted to conventional multiport laparoscopy. No patients required conversion to open surgery, nor were any intraoperative complications reported. Length of hospitalization was 2.4 ± 1.6 days. The overall 90-day postoperative complication rate was 18.6%, mostly low-grade complications (Clavien I-II). With a mean follow-up of 14.0 ± 10.8 months, 93.4% had resolution of symptoms and 94.4% had radiographic evidence demonstrating resolution of ureteropelvic junction obstruction. Assessment of drainage with diuretic nuclear renal scan provided evidence of improvement in 86.5% of patients on their first postoperative renal scan. This study highlights the most comprehensive experience with LESS-P reported to date. Outcome measures parallel those of large published series of conventional laparoscopic pyeloplasty. Despite these encouraging findings, longer follow-up is needed to determine the efficacy and durability of this approach for the treatment of ureteropelvic junction obstruction.

834 RENAL FUNCTION OUTCOMES FOLLOWING LAPAROENDOSCOPIC SINGLE-SITE (LESS) PYELOPLASTY

You have accessJournal of UrologyTechnology & Instruments: Laparoscopy: Malignant & Benign Disease1 Apr 2013834 RENAL FUNCTION OUTCOMES FOLLOWING LAPAROENDOSCOPIC SINGLE-SITE (LESS) PYELOPLASTY Aditya Bagrodia, Brian Harrow, Ephrem Olweny, Stephen Faddegon, Jeffrey Cadeddu, and Jeffrey Gahan Aditya BagrodiaAditya Bagrodia Dallas, TX More articles by this author , Brian HarrowBrian Harrow Dallas, TX More articles by this author , Ephrem OlwenyEphrem Olweny New Brunswick, NJ More articles by this author , Stephen FaddegonStephen Faddegon Dallas, TX More articles by this author , Jeffrey CadedduJeffrey Cadeddu Dallas, TX More articles by this author , and Jeffrey GahanJeffrey Gahan Dallas, TX More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.401AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Outcomes following laparoendoscopic single-site (LESS) pyeloplasty are limited to small cohorts with short-term follow up. The purpose of this study is to evaluate intermediate-term clinical and renal function outcomes of robotic LESS (R-LESS) and conventional LESS (C-LESS) pyeloplasty using diuretic renal scans and estimated glomerular filtration rate (eGFR). METHODS Consecutive patients presenting with ureteropelvic junction obstruction (UPJO) were evaluated by a single surgeon. Diagnosis of UPJO in each case was confirmed radiographically with abdominal computed tomography and diuretic renography. Radiographic obstruction (defined as T1/2 >20 min) was seen in 65% of patients at presentation. All patients who underwent robotic LESS (R-LESS) or conventional LESS (C-LESS) pyeloplasty were entered into a prospectively maintained database. Patient demographics, clinical, perioperative, and postoperative renal function outcomes were recorded. Double-J stents were removed after 4-6 weeks. Postoperative diuretic renography was performed approximately 6 weeks after stent removal, then at 6 months, and yearly thereafter. Clinical (symptomatic response) and radiographic outcomes were documented in each case. RESULTS Fifty-three patients underwent LESS pyeloplasty by a single surgeon from October 2007 to July 2012 (31 C-LESS: 22 R-LESS). Mean follow-up was 12.1 months. Mean operative time and mean blood loss were 202 minutes and 35 ml, respectively. Median hospital stay was 2.0 days. Conversion to open operations occurred in 4 LESS surgeries for failure to progress (7.8%). No intraoperative complications occurred. Postoperative complications occurred with 11 patients (21%). Of these, 9 were > Clavien Grade 3, 7 of which occurred in the C-LESS group. Symptomatic resolution was achieved in 49/51 cases (96.1%). Renal T½ improved in 95.5% of patients. Postoperative split renal function and eGFR improved in 89% and 79% of cases respectively, but were not statistically different from preoperative values. Diuretic renal scans performed at an average of 10.3 months following stent removal indicated radiographic resolution of obstruction (T1/2 ≤ 20 min) in 41/44 cases (93.2%) for the cohort. Paired differences in preoperative and postoperative T1/2 were statistically significant at p<0.01 for the overall cohort. CONCLUSIONS LESS pyeloplasty, when performed robotically or laparoscopically, is safe and efficacious. Both approaches provide excellent intermediate-term outcomes in terms of symptomatic relief and radiographic resolution of obstruction. © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e342 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Aditya Bagrodia Dallas, TX More articles by this author Brian Harrow Dallas, TX More articles by this author Ephrem Olweny New Brunswick, NJ More articles by this author Stephen Faddegon Dallas, TX More articles by this author Jeffrey Cadeddu Dallas, TX More articles by this author Jeffrey Gahan Dallas, TX More articles by this author Expand All Advertisement Advertisement PDF DownloadLoading ...

Renal Function After Laparoendoscopic Single Site Pyeloplasty

Outcomes after laparoendoscopic single site pyeloplasty are limited to small cohort studies with short-term followup. We evaluated the clinical and renal function outcomes of what to our knowledge is the largest laparoendoscopic single site pyeloplasty cohort to date with a mean followup of 12 months. Consecutive patients diagnosed with symptomatic ureteropelvic junction obstruction who underwent robotic or conventional laparoendoscopic single site pyeloplasty were entered into the study. Patient demographics, and preoperative and postoperative renal function outcomes were recorded. Diuretic renogram was performed after stent removal, at 6 months and yearly thereafter. The cohort included 31 conventional and 22 robotic laparoendoscopic single site pyeloplasties. Four laparoendoscopic single site surgeries (7.8%) were converted to another procedure due to failure to progress. Mean ± SD followup was 12.1 ± 10.7 months and 22 patients had at least 12 months of followup. No intraoperative complications occurred. Complications developed postoperatively in 11 patients (21%), of which 9 were Clavien grade 3 or greater. Preoperative symptoms resolved in 49 of 51 cases (96%). Severe obstruction (half-time greater than 20 minutes) was seen in 32 of 44 patients (73%) at presentation and obstruction resolved (half-time 20 minutes or less) in 41 (93%). Mean preoperative and postoperative half-time was 24.6 ± 13.4 and 8.3 ± 4.1 minutes, respectively, for an improvement of 16.3 ± 12.3 minutes (p <0.01). Laparoendoscopic single site pyeloplasty is safe and efficacious. The laparoscopic and robotic techniques provide excellent outcomes in terms of symptomatic relief and radiographic resolution of obstruction.

Laparoendoscopic single‐site versus conventional transperitoneal laparoscopic pyeloplasty: A prospective randomized study

To evaluate the potential benefits of laparoendoscopic single-site pyeloplasty over conventional laparoscopic pyeloplasty. Between October 2009 and January 2012, 39 patients were enrolled in a prospective study and randomized to undergo a laparoendoscopic single-site pyeloplasty (n = 19) or conventional laparoscopic pyeloplasty (n = 20). The outcomes in the two groups were compared by using Mann-Whitney U-test and χ(2) -test, and considering a P-value less than 0.05 as statistically significant. There was no difference in blood loss (55.67 ± 6.71 vs 45.84 ± 5.22 mL, P = 0.60), transfusion rates (0% for both) and hospitalization time (2.12 ± 0.23 vs 2.06 ± 0.34 days, P = 0.72) between the laparoendoscopic single-site pyeloplasty and conventional laparoscopic pyeloplasty groups. The time to return to normal activities was shorter (8.65 ± 1.25 vs 11.53 ± 1.28 days, P = 0.01), and median operative time (195.21 ± 12.15 vs 145.62 ± 15.34 min, P = 0.001) was longer in the laparoendoscopic single-site pyeloplasty group compared with the conventional laparoscopic pyeloplasty group. No significant intraoperative or postoperative complications occurred in either group. Compared with conventional laparoscopic pyeloplasty, laparoendoscopic single-site pyeloplasty yielded better cosmetic results and patient satisfaction. The mean follow-up period was 19.7 months (4-28 months). The success rate was 95% in both the groups. Both the visual analog scale and the postoperative use of analgesics were significantly lower in patients who underwent laparoendoscopic single-site pyeloplasty. Our findings suggest that laparoendoscopic single-site pyeloplasty can offer faster recovery and higher patient satisfaction than conventional laparoscopic pyeloplasty. Thus, this novel technique promises to become the treatment of choice in minimally-invasive management of ureteropelvic junction obstruction.

Laparoendoscopic single‐site pyeloplasty for recurrent pelvic–uretero junction obstruction

Surgical PracticeVolume 17, Issue 1 p. 34-34 Multi-Media Article Laparoendoscopic single-site pyeloplasty for recurrent pelvic–uretero junction obstruction Peter K.F. Chiu, Peter K.F. Chiu Department of Surgery, Queen Elizabeth Hospital, Hong KongSearch for more papers by this authorSteve W.H. Chan, Steve W.H. Chan Department of Surgery, Queen Elizabeth Hospital, Hong KongSearch for more papers by this authorSteffi K.K. Yuen, Steffi K.K. Yuen Department of Surgery, Queen Elizabeth Hospital, Hong KongSearch for more papers by this authorLap-Yin Ho, Lap-Yin Ho Department of Surgery, Queen Elizabeth Hospital, Hong KongSearch for more papers by this authorWing-Hang Au, Wing-Hang Au Department of Surgery, Queen Elizabeth Hospital, Hong KongSearch for more papers by this author Peter K.F. Chiu, Peter K.F. Chiu Department of Surgery, Queen Elizabeth Hospital, Hong KongSearch for more papers by this authorSteve W.H. Chan, Steve W.H. Chan Department of Surgery, Queen Elizabeth Hospital, Hong KongSearch for more papers by this authorSteffi K.K. Yuen, Steffi K.K. Yuen Department of Surgery, Queen Elizabeth Hospital, Hong KongSearch for more papers by this authorLap-Yin Ho, Lap-Yin Ho Department of Surgery, Queen Elizabeth Hospital, Hong KongSearch for more papers by this authorWing-Hang Au, Wing-Hang Au Department of Surgery, Queen Elizabeth Hospital, Hong KongSearch for more papers by this author First published: 07 December 2012 https://doi.org/10.1111/1744-1633.12005Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article. Volume17, Issue1February 2013Pages 34-34 This article also appears in:Multi-Media Articles RelatedInformation

Robotic-Assisted Pyeloplasty:Recent Developments in Efficacy, Outcomes, and New Techniques

Within the last decade, the adaptation of robotic urologic surgery has had a profound impact on surgical practice, with robotic upper tract reconstruction for ureteropelvic junction obstruction gaining rapid acceptance. Recent advances in robotic reconstruction demonstrate efficacious outcomes of robotic pyeloplasty, as compared with conventional laparoscopic pyeloplasty, even in the case of secondary surgery. Furthermore, efforts to continue to reduce the morbidity of laparoscopic surgery have led to the development and implementation of laparoendoscopic single-site (LESS) surgery. The recent applications of the da Vinci robotic surgical platform to LESS pyeloplasty (R-LESS) has demonstrated the potential to further decrease morbidity, improve surgeon ergonomics, and improve cosmesis.

Robot-Assisted Laparoendoscopic Single-Site Pyeloplasty: Technique Using the da Vinci Si Robotic Platform

Conventional laparoscopic dismembered pyeloplasty (LP) is an established alternative to open pyeloplasty given equivalent intermediate-term outcomes and decreased morbidity. Laparoendoscopic single-site (LESS) pyeloplasty has the potential to further decrease the morbidity of LP, while yielding superior cosmesis. It is, however, technically very challenging even with the use of an accessory port, largely because of the difficulty of intracorporeal suturing through a single umbilical incision. Application of the da Vinci robotic surgical platform to LESS pyeloplasty (R-LESS) has the potential to overcome these limitations. We describe our technique for R-LESS pyeloplasty using the da Vinci Si robot. We have found that use of the robotic system in conjunction with certain technique modifications helps to reduce the technical difficulty of LESS pyeloplasty and to shorten the physical learning curve associated with the procedure.

V547 LAPAROENDOSCOPIC SINGLE-SITE PYELOPLASTY: COMPARED LESS PYELOPLASTY WITH CONVENTIONAL LAPAROSCOPIC PROCEDURE

You have accessJournal of UrologyPediatrics1 Apr 2012V547 LAPAROENDOSCOPIC SINGLE-SITE PYELOPLASTY: COMPARED LESS PYELOPLASTY WITH CONVENTIONAL LAPAROSCOPIC PROCEDURE Yasuyuki Naitoh, Akihiro Kawauchi, Jintetsu Soh, Kazumi Kamoi, and Tsuneharu Miki Yasuyuki NaitohYasuyuki Naitoh Kyoto, Japan More articles by this author , Akihiro KawauchiAkihiro Kawauchi Kyoto, Japan More articles by this author , Jintetsu SohJintetsu Soh Kyoto, Japan More articles by this author , Kazumi KamoiKazumi Kamoi Kyoto, Japan More articles by this author , and Tsuneharu MikiTsuneharu Miki Kyoto, Japan More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.621AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Laparoendoscopic single-site surgery (LESS) for pediatric patients has been reported from some institutions. We have quickly applied this procedure for pyeloplasty to treat patients with hydronephrosis. METHODS A total of 18 LESS pyeloplasty cases performed in our clinic since 2008 were entered in this study.We compared LESS pyeloplasty with conventional laparoscopic procedure using age-matched cohort of patients.After making a 12-15mm umbilical vertical incision, a LESS specific port, Triport ®that has two 5-mm and one 10-mm working ports and a gas insufflation channel, was indwelled. A 5mm flexible scope was utilized as an optical visual tube, and 5-mm forceps with a flexible tip and regular laparoscopic devices were used. RESULTS The mean age of the patients was 20.3 years (range1-56 years). LESS pyeloplasty was performed on the right in 8 cases and on the left in 10 cases. The operative time was 255±74 minutes (mean±SD). Regarding the nine pediatric patients, the mean age of the patients was 4.8 years (range1-10 years). The operative time was 253±47 minutes. As for the nine adult patients, the mean age of the patients was 35.7 years (range16-56 years).The operative time was 257±93 minutes. Mean operative time of the control group, an age-matched laparoscopic pyeloplasty (18 cases) was 246±62 minutes. It was 221±56 minutes for the pediatric patients (9 cases) and 241±81 minutes for the adult patients (9 cases). There was no significant difference in the operative time between the control group and the LESS group for both adults and children. Blood loss was minimal and no intraoperative and postoperative complications were observed in the 18 LESS pyeloplasty cases. Oral intake started 1.5 days after operation. The pain scale (Max: 5) reached 2.7, the highest, on Day 0 post operation, then became 2.0 on Day 1, 1.6 on Day 2 and 0.1 on Day 4. CONCLUSIONS LESS for pediatric patients has just begun, and the number of experience is still small. This procedure demonstrated its less invasiveness and is feasible for pediatric patients as well as adults. Being cosmetically highly favorable, in the future, this procedure will likely to be further distributed. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e224 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Yasuyuki Naitoh Kyoto, Japan More articles by this author Akihiro Kawauchi Kyoto, Japan More articles by this author Jintetsu Soh Kyoto, Japan More articles by this author Kazumi Kamoi Kyoto, Japan More articles by this author Tsuneharu Miki Kyoto, Japan More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Feasibility and Preliminary Clinical Outcomes of Robotic Laparoendoscopic Single-Site (R-LESS) Pyeloplasty Using a New Single-Port Platform

This study tested the technical feasibility and short-term perioperative outcomes of the novel da Vinci Single-Site Instrumentation platform for the treatment of upper ureteropelvic junction obstruction (UPJO) in a selected group of patients. Nine patients underwent robotic laparoendoscopic single-site (R-LESS) pyeloplasty using a new single-site platform for UPJO at our department of urology.All the procedures were completed without the need for traditional robotic surgery or laparoscopic/open conversion, although in one patient with congenital hepatomegaly it was necessary to use an auxiliary 3-mm trocar to retract the liver properly and expose the surgical field. Mean operative time was 166min, and no intraoperative complications were recorded. The indwelling catheter was removed on postoperative day 2 in five patients and on postoperative day 3 in four patients. Patients were discharged the day after drain removal. One patient experienced transient hyperpyrexia, treated with antibiotics. No other complications were observed. All patients had the DJ stent removed 4 wk after surgery, following a negative urine culture and abdominal ultrasound evaluation. The five patients who reached a 3-mo follow-up had a clinical resolution of preoperative symptoms and hydronephrosis at the abdominal ultrasound. The same results were maintained in the two patients with 6-mo follow-up evaluations.In selected patients, R-LESS pyeloplasty using the new single-port platform appears to be a technically feasible and reproducible surgical procedure for the minimally invasive treatment of UPJO. Prolonged follow-up and larger series are required to confirm its potential role as a valid alternative to standard robotic pyeloplasty.