Laparoscopic Dismembered Pyeloplasty

TLDR

Laparoscopic nephrectomy has become a viable ablative procedure, prompting investigation into other reconstructive laparoscopic urological techniques. The study reports early experience with laparoscopic pyeloplasty to treat ureteropelvic junction obstruction. The technique involved internal ureteral stenting, lateral insufflation, placement of 5‑ and 10‑mm trocars, pyelotomy with articulating scissors, reapproximation of the ureteropelvic junction using a running 4‑0 polyglactin suture, placement of a 7‑mm suction drain, and reapproximation of the colon to the body wall with a hernia stapler, performed in five patients with operative times of 3–7 hours largely spent on laparoscopic suturing. All five patients had an average 3‑day hospital stay, returned to normal activity within a week, and achieved complete symptom resolution at 12‑month follow‑up, supporting the procedure’s efficacy for complex ureteropelvic junction obstruction.

Abstract

As laparoscopic nephrectomy has become a viable ablative procedure for kidney removal, additional areas of reconstructive laparoscopic urological procedures are being investigated. We describe our early experience with laparoscopic pyeloplasty for the management of ureteropelvic junction obstruction. Technical highlights include initial placement of an internal ureteral stent, lateral insufflation, placement of 5, 10 mm. trocars, pyelotomy (or reduction pyeloplasty performed with articulating laparoscopic scissors, reapproximation of the ureteropelvic junction with a running 4-zero polyglactin suture, placement of a 7 mm. suction drain in the retroperitoneal space and reapproximation of the colon to the body wall with a hernia stapler. We have performed laparoscopic dismembered pyeloplasty in 5 patients with symptomatic ureteropelvic junction obstruction. Operating time ranged from 3 to 7 hours, with the majority of time devoted to laparoscopic suturing (1 to 3 hours). Hospital stay averaged 3 days and all patients returned to normal activity within 1 week. Followup averaged 12 months (range 9 to 17 months) with complete resolution of symptoms in all patients. We believe that this innovative reconstructive laparoscopic procedure can be used for treatment of complicated ureteropelvic junction obstruction as in patients with a large, redundant renal pelvis or crossing lower pole vessels.