V580: Minimal access laparoscopic-assisted pediatric pyeloplasty
VideoIntroduction and Objectives
Pediatric pyeloplasty has progressed with technical advances, including laparoscopic and robotic techniques, to decrease morbidity and improve cosmesis. In pediatric urology, the technical difficulty of intracorporeal suturing has limited the usage of pure laparoscopic pyeloplasty. Robotic-assisted pyeloplasty requires costly equipment and is not available in many practice settings. We present a technique for pediatric pyeloplasty which incorporates elements of single-site laparoscopy and open pyeloplasty to improve the technical ease as well as cosmetic outcomes of the procedure.
Retrograde pyelogram is performed and a double-J ureteral stent is placed. A single 2cm transumbilical incision is made to accommodate a 5mm laparoscopic port, a bariatric length 45 degree telescope, and a Maryland grasper. Traditional laparoscopic techniques are used to mobilize the renal pelvis and ureter through this single site. A 1cm flank incision is made through which a 5mm port is inserted into the abdomen. Through the flank port, holding sutures are placed in the renal pelvis and ureter. The UPJ is brought extracorporeally and a traditional Anderson-Hynes open pyeloplasty is performed. No drains are placed and patients are discharged on post-operative day 1.
A total of 6 cases have been performed with median operative time of 227 minutes (range 180-297). Only basic laparoscopic instruments and skill set are required for the dissection. Extracorporeal suturing allows for the most technically challenging aspect of the case to be performed in a standard open fashion. The umbilical scar is hidden and the 1cm flank incision is the only apparent scar.
Minimal access laparoscopic-assisted pediatric pyeloplasty is a novel technique that is less technically demanding than pure laparoscopic pyeloplasty and can be disseminated into practice environments where a robot is not available, all the while offering cosmesis equal to or better than other minimally invasive approaches.