Cost‐effective laparoscopic pyeloplasty: Single center experience

Abstract

SummaryObjective : Laparoscopic pyeloplasty (LPP) is a minimally invasive treatment option for ureteropelvic junction (UPJ) obstruction. We report here our experience of performing cost-effective LPP on 24 patients at a single center. Methods : Between October 1999 and March 2002, LPP was performed in 24 patients (17 male, seven female; age range 8-51 years) including two patients who had failed previous endourologic treatments. In two patients with concomitant renal stones, laparoscopic pyelolithotomy was also performed. LPP was conducted in a cost-reductive manner by both transperitoneal ( n = 12) and retroperitoneal ( n = 12) access. To reduce the cost, an indigenous balloon to create the retroperitoneal space, reusable ports, ordinary polyglactin suture and intracorporeal free-hand suturing were employed. To reduce operative time, antegrade stenting was also performed in some cases.Results : Laparoscopic Anderson-Hynes pyeloplasty was performed in 16, Foley Y-V pyeloplasty in five and Fenger pyeloplasty in three patients. One patient required conversion to open surgery due to tension at the anastomosis site during Anderson-Hynes pyeloplasty. The mean operating time, blood loss, analgesic (pethidine) requirement, duration of drain and hospital stay for the retroperitoneal and transperitoneal groups were 170.3 and 187.6 min, 102.2 and 145.9 mL, 125 and 136.4 mg, 2.1 and 2.5 days, and 3.4 and 4.3 days, respectively. No significant complications were encountered apart from prolonged ileus in three patients in the transperitoneal group. The mean follow-up period was 10.8 months with a range of 2-24 months. Postoperative renal scan was performed at 3 months in 21 patients, and 1 year in 11 patients. There was evidence of equivocal obstruction in one patient, but there were no obstructions in the remaining patients. Conclusion

Robot assisted laparoscopic pyeloplasty in patients of ureteropelvic junction obstruction with previously failed open surgical repair

“…We had reported that most UPJ obstructions can be cost-effectively managed laparoscopically including those that have failed endopyelotomy or have a dilated renal pelvis, coexisting renal calculous disease, abnormalities of position or rotation, and those with associated crossing vessels. 2 Although the laparoscopic technique mimics open surgery, it is not as versatile, however, and it becomes technically more challenging in cases of failed pyeloplasty. With the availability of the robot at our institute, we explored its potential use in these difficult situations.…”

Laparoscopic nephroplication and nephropexy as an adjunct to pyeloplasty in UPJO with giant hydronephrosis

“…Anderson-Hynes pyeloplasty, as described by us earlier [3]. The pyeloplasty was then performed with intra-corporeal free hand suturing using ordinary 4-0 Vicryl suture.…”

Future trends in minimally invasive surgery

“…Medical literature is filled with articles about endoscopic surgery that address topics such as cost‐effectiveness, 11,30–34 identification of surgical procedures that benefit from endoscopic technique, 35 , 36 outcome data, 37 , 38 and surgical patient selection 39 , 40 . Many investigators have reported favorable outcomes for patients undergoing MIS procedures, including reduced surgical times, and decreased hospital stays even for patients who have complicated injuries or disease processes 36–38 .…”