V07-08: Laparoscopic pediatric pyeloplasty using the Flexdex® articulating needle driver
Ureteropelvic junction (UPJ) stenosis is the most common cause of neonatal hydronephrosis. In patients screened by antenatal ultrasound, the incidence go as high as 1 case per 500 live births. The cause of the UPJ stenosis can be intrinsic or due to an extrinsic compression by an accessory renal artery. The patient with UPJ obstruction can be asymptomatic through his whole life or present with recurrent flank pain and/or urinary tract infection. While many cases can be treated conservatively, surgery is indicated if symptoms occurs or renal function deteriorates. Pyeloplasty is the procedure of choice for UPJ stenosis. Pyeloplasty can be done by open, laparoscopic or robotic technique. The laparoscopic technique is safe and feasible in high-volume centers and may be associated with shorted length of hospital stay and reduced complications. Lately, robotic pyeloplasty has been done with similar results adding the benefits of easier suturing manoeuvrability, but with increased costs. Flexdex® is a laparoscopic articulating needle driver that improves maneuverability and ergonomics.
We describe a 6 year-old patient with left lumbar and flank pain diagnosed with UPJ stenosis. The patient performed a DTPA scintigraphy with following findings: left kidney time to peak = 5min; left kidney time from peak to ½ peak = not achieved; left kidney after diuretic time from peak to ½ peak = not achieved. The patient underwent a laparoscopic pyeloplasty with the Flexdex® needle driver.
The operative time was 90 minutes. The case was done without any intraoperative complications, no significant blood loss and the patient was discharged the day after the procedure. A double J stent was placed intraoperatively and removed after two weeks. This was the first described pediatric pyeloplasty performed using the Flexdex ® needle driver. After 90 days of follow-up, there was no complications reported and the patient reported no more back pain.
Laparoscopic pyeloplasty using Flexdex® is feasible and can be easily be done in centers with expertise in laparoscopic surgeries.
Funding: Flexdex donated one laparoscopic articulating needle driver for testing. The donation was not made for publishing purposes.