V04-04: Laparoscopic in situ dismembered pyeloplasty to facilitate laparosopic ureteropelvic junction obstruction repair
Correct orientation of ureteric spatulation, and prevention of twisting of the ureter, may make laparoscopic dismembered pyeloplasty a challenging procedure. In this video we presented the technique of laparoscopic in situ dismembered pyeloplasty as a modified technique during which the alignment of ureter and renal pelvis remains intact during ureteropelvic junction (UPJ) anastomosis. We also assessed intraoperative and postoperative outcomes of this modification in comparison to standard laparoscopic dismembered pyeloplasty.
Patients with significant primary UPJ obstruction without any previous history of abdominal surgery, high ureter insertion or renal anomalies were considered. The patients were consecutively enrolled one after another into one of two study groups: classic laparoscopic dismembered pyeloplasty (Group I) or laparoscopic in situ dismembered pyeloplasty (Group II), however, those with aberrant vessels crossing the UPJ were allocated specifically to Group I because UPJ anastomosis should be done anterior to the aberrant vessels. Demographic data, intraoperative timings, postoperative and follow-up outcomes were compared.
Patients in Group I (n=23) and Group II (n=14) had similar demographic characteristics. Mean operative time was significantly longer in Group I (103.8±19.95 min versus 89.5±18.90 min, P=0.038). Total duration of UPJ repair and anastomosis was also significantly longer in Group I (92.7±15.82 versus 78.4± 14.76 min, P=0.021). The method of pyeloplasty significantly affected the time required to prepare ureter and renal pelvis (P=0.017) and the duration of UPJ anastomosis (P=0.014) (Figure 1). Both were shorter in Group II. Mean follow-up period was 14.4±7.42 months in Group I and 14.05±7.93 months in Group II (P=0.88). Success rate was 95.6% in Group I and 100% in Group II (P=0.42).
Laparoscopic in situ pyeloplasty is a safe and effective approach to simplify laparoscopic pyeloplasty, especially at teaching centers where surgeons with variable levels of experience perform laparoscopic procedures.