Assisted Laparoscopic Pyeloplasty Research Articles

P117 Surgical management of Ureteropelvic Junction Obstruction (UPJO) in Neonates amid COVID-19 pandemic; Review of Literature and a Cohort Study in Iran

IntroductionThe current study presents a systematic review of literature on surgical management of ureteropelvic junction obstruction (UPJO) alongside an ongoing cohort study of neonates presenting with high grades of hydronephrosis due to UPJO requiring urgent treatment in a developing country amid the COVID-19 pandemic. The aim of this study is to investigate the efficacy and cost effectiveness of laparoscopic-assisted pyeloplasty.MethodsPatients’ demographics, clinical presentations and treatment outcomes are recorded. The cohort is classified into 3 groups based on type of surgical treatment offered including open, laparoscopic and laparoscopic-assisted pyeloplasty. All patients admitted with grade 3-4 hydronephrosis due to UPJO are included. Patients with UPJO as part of a complex multisystemic syndrome are excluded. Literature review was conducted from 2000/1/1 to 2020/1/1 to include all original research papers on surgical management of UPJO. The age group was limited to neonates (under 1 year-old).Results32 articles were included in the review. 20 papers (62.5%) recommended open pyeloplasty, 10 papers (31.3%) recommended laparoscopic pyeloplasty and 2 papers (6.25%) recommended laparoscopic-assisted pyeloplasty. The cohort study is currently recruiting patients treated by the 3 surgical approaches.ConclusionThe majority of studies are focusing on open pyeloplasty. However, as more surgeons are going through the learning curve of laparoscopic pyeloplasty, the trend is towards more laparoscopic management in the future. It is important to discover the advantages of laparoscopic-assisted approach as a new technique to improve the outcome and shorten the hospital stay amid the COVID-19 pandemic.

Five years’ experience of laparoscopic-assisted dismembered pyeloplasty versus open dismembered pyeloplasty

Purpose Pyeloplasty for ureteropelvic junction obstruction (UPJO) in children has traditionally been performed using an open technique. However, the large lumbar incision in open pyeloplasty necessitates several weeks before a return to normal activity and requires significant tissue retraction to expose the field; hence, the damage is often more than that anticipated. We present our long-term experience with laparoscopic-assisted pyeloplasty in the treatment of UPJO, to evaluate the feasibility, safety, and long-term outcome of this technique in children. Patients and methods In total, 40 children with UPJO requiring operative repair were included in the study. Twenty patients with UPJO were randomly selected to undergo open dismembered pyeloplasty (group A) and the remaining 20 patients to undergo laparoscopic-assisted dismembered pyeloplasty (group B) at the Pediatric Surgery Department between January 2013 and December 2017. All patients were followed-up for 5 years postoperatively. The outcome was measured by the ultrasonography and diuretic renography with resolution of obstructive symptoms. Results The mean laparoscopic procedure time was 25 min. There was a slight relationship between age and operative time. No major perioperative complications occurred in any cases. Renal pelvic anterior–posterior diameter at postoperative ultrasonography significantly decreased (P<0.05). Postoperative split renal function on diuretic renography significantly improved. Overall, successful resolution of UPJO was observed in all patients. Conclusion Laparoscopic-assisted pyeloplasty appears to be a safe, feasible, and effective alternative to open pyeloplasty in children. There are shorter operative times in the laparoscopic-assisted pyeloplasty and shorter overall hospitalization. It avoids large lumbar incision and gives excellent functional and cosmetic results. Keywor ds : laparoscopy-assisted pyeloplasty, minimally invasive surgery, ureteropelvic junction obstruction

Laparoscopic-Assisted Extracorporeal Pyeloplasty: A Minimally Invasive Approach to Pediatric Ureteropelvic Junction Obstruction

Background: Ureteropelvic junction obstruction (UPJO) is a common congenital anomaly in pediatrics that may require surgical intervention performed by open, laparoscopic-assisted, laparoscopic, or robotic-assisted fashion. Laparoscopic pyeloplasty hasn't become popular due to instrument or skill limitations. Laparoscopic-assisted pyeloplasty could be the first step towards a minimally invasive approach to UPJO in pediatrics. Methods: The current study was conducted on 60 infants with UPJO treated with either laparoscopic-assisted extracorporeal or open pyeloplasty. In our modified approach, the ureteropelvic junction was exposed and released laparoscopically and pulled out of the abdominal cavity and pyeloplasty was performed simply over a JJ stent. The second group was treated by conventional posterior lumbotomy approach. All patients were followed up after the operation at least for six months and the results were compared between the two groups. Results: Comparison of the pelvic anteroposterior diameter before and after the operation indicated a significant reduction after the operation in both groups. Diuretic scan after JJ catheter removal did not show signs of obstruction in almost all cases among both groups. Comparison of the postoperative complications revealed no significant differences between the two groups. The complication rate was also very low and almost the same in both groups. Conclusions: Full laparoscopic pyeloplasty demands advanced surgical skills and fine instruments, which made it time-consuming and less applicable widely. Laparoscopic-assisted pyeloplasty is more applicable while it showed acceptable results in the current study. The current approach is suggested as the first step toward MIS for UPJO in pediatrics.

One-Trocar–Assisted Pyeloplasty in Children: An 8-Year Single Institution Experience

Ureteropelvic junction obstruction (UPJO) is the most common pediatric obstructive uropathy. We report our 8-year experience with the use of a retroperitoneal laparoscopic-assisted pyeloplasty (one-trocar-assisted pyeloplasty [OTAP]). This is a retrospective analysis of 88 patients treated in 8 years. Surgery was performed on the basis of standard indications and it consisted of 88 OTAP (the ureteropelvic junction is identified through a retroperitoneoscopic inspection and it is exteriorized to perform a traditional dismembered pyeloplasty). Operative time, hospital stay, complication, success of the technique, and aesthetical results are analyzed. In the 8-year period we performed 88 OTAP. Mean age was 19 months. Prenatal diagnosis was the most common presentation (n = 73), followed by occasional identification (n = 8), and symptomatic (n = 7). Mean operating time was 139 minutes (range 60-225 minutes). Conversion was required in seven cases. The success rate was 87.5% (reduction of the severity of hydronephrosis on ultrasound) and 100% among symptomatic patients (symptoms resolution). Aesthetical results were excellent. OTAP is safe, feasible, and efficacious. Operative times are similar or even shorter than those of other minimally invasive techniques and complication rate agrees with the findings of literature. OTAP can be considered a reasonable alternative.

Laparoscopic-Assisted Pyeloplasty in Children

Between June 2000 and January 2002 we performed laparoscopic-assisted Anderson-Hynes pyeloplasty in 5 children with pelvi-uretric junction (PUJ) obstruction. Their ages ranged from 3 months to 10 y...

V19 Robotic assisted laparoscopic dismembered pyeloplasty

V19 Robotic assisted laparoscopic dismembered pyeloplasty