Laparoendoscopic Single-site Pyeloplasty: Outcomes of an International Multi-institutional Study of 140 Patients

Rais‐Bahrami, Soroush; Rizkala, Emad; Cadeddu, Jeffrey A.; Tuğcu, Volkan; Derweesh, Ithaar; Abdel-Karim, Aly M.; Kawauchi, Akihiro; George, Arvin; Autorino, Riccardo; Bagrodia, Aditya; Sönmezay, Erkan; Élsalmy, Salah; Liss, Michael A.; Harrow, Brian M.; Kaouk, Jihad; Richstone, Lee; Stein, Robert J.

doi:10.1016/j.urology.2013.04.047

Cited by 21 publications

(15 citation statements)

References 30 publications

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“…Like other procedures, reports on LESS pyeloplasty compare LESS and a conventional method, and examine the surgical outcomes, but there are no reports comparing the same procedure in adult and pediatric patients. We initiated LESS pyeloplasty after multiple experiences of the conventional method, and participated in a multi‐institutional study for LESS pyeloplasty . Although this is not a prospective study, we report here the outcomes of LESS pyeloplasty using the results of the previous conventional method before adopting LESS as the control.…”

Section: Discussionmentioning

confidence: 99%

“…We initiated LESS pyeloplasty after multiple experiences of the conventional method, and participated in a multi-institutional study for LESS pyeloplasty. 15 Although this is not a prospective study, we report here the outcomes of LESS pyeloplasty using the results of the previous conventional method before adopting LESS as the control. This is the first report to compare LESS pyeloplasty outcomes in both pediatric and adult patients within the same facility.…”

Section: Discussionmentioning

confidence: 99%

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Laparoendoscopic single‐site versus conventional laparoscopic pyeloplasty: A matched pair analysis

et al. 2014

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Objective:To compare the outcomes of laparoendoscopic single-site pyeloplasty versus those of conventional laparoscopic pyeloplasty. Methods: A total of 26 laparoendoscopic single-site pyeloplasty cases carried out in University Hospital: Kyoto Prefectural University of Medicine, Kyoto, Japan, from 2008 to 2013 were compared with a control group of 26 age-matched laparoscopic pyeloplasty cases carried out during the same study period. Results: The mean age of the patients was 20.4 years (range 1-56 years). Laparoendoscopic single-site pyeloplasty was carried out on the right in nine cases and on the left in 17 cases. The operative time was 246 ± 68 min. Regarding the 14 pediatric patients, the mean age was 7.1 years (range 1-14 years). The operative time was 243 ± 49 min. As for the 12 adult patients, the mean age was 35.8 years (range 16-56 years). The operative time was 248 ± 86 min. The mean operative time of the control group in age-matched laparoscopic pyeloplasty was 239 ± 51 min. Times were 229 ± 54 min for the pediatric patients and 253 ± 45 min for the adult patients. There was no significant difference in the operative time between the control group and the laparoendoscopic single-site group for both adults and children. Blood loss was minimal, and no intraoperative and postoperative complications were observed in the 26 laparoendoscopic single-site pyeloplasty cases. Conclusion:The present findings suggest that laparoendoscopic single-site pyeloplasty can be used in both pediatric and adult patients, offering a superior cosmetic outcome than conventional laparoscopic pyeloplasty, and a lower degree of postoperative pain. A largescale prospective, randomized study is required to confirm these findings, and to define the future role of laparoendoscopic single-site pyeloplasty.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Laparoendoscopic single‐site versus conventional laparoscopic pyeloplasty: A matched pair analysis

et al. 2014

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“…[ 5 27 ] However, the challenges of the technique have been partially overcome with the use of articulating or prebent instruments, different access platforms, and use of needlescopic or minilaparoscopic instruments to facilitate triangulation. [ 5 28 ] Stein et al reported using a combination of standard and articulating laparoscopic instruments through a trans-umbilical access where a Triport (ASC, Wickliffe, Ireland) was introduced. [ 22 ] Ju et al made a single 2 cm incision at the umbilicus and used a homemade port prepared using an Alexis ® wound retractor (Applied Medical, Rancho Santa Margarita, CA, USA) and a glove.…”

Section: Discussionmentioning

confidence: 99%

Laparoendoscopic single site surgery versus conventional laparoscopy for transperitoneal pyeloplasty: A systematic review and meta-analysis

et al. 2015

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We aimed to review studies comparing the outcomes of the laparoendoscopic single site (LESS) pyeloplasty with those of conventional laparoscopic pyeloplasty (CLP). A systematic review of the literature was performed according to the PRISMA (preferred reporting items for systematic reviews and meta-analysis) criteria. The methodological quality of the studies was rated according validated scales. The level of evidence (LE) was reported as described by the Oxford criteria. Preoperative demographic parameters and perioperative outcomes between the two surgical techniques were assessed. A meta-analysis of the included studies was performed. A total of 5 studies were elected for the analysis, including 164 cases, 70 (42.6%) of them being LESS and 94 (57.4%) being CLP. Four studies were observational retrospective comparative studies (LE: 3a-4); one was a prospective randomized controlled trial (LE: 2b). There was no significant difference in age, body mass index, gender, side and presence of the crossing vessel, between the groups. There was no significant difference regarding the operative time (weight mean difference [WMD]: −7.02; 95% confidence interval [CI]: −71.82–57.79; P = 0.83) and length of hospital stay (WMD: 0.04; 95% CI: −0.11–0.20; P = 0.58), whereas the estimated blood loss was statistically lower for LESS (WMD: −16.83; 95% CI: −31.79–−1.87; P = 0.03). The postoperative use of analgesic favored the LESS group but without reaching statistical significance (WMD: −7.52; 95% CI: −17.56–2.53; P = 0.14). In conclusion, LESS pyeloplasty offers comparable surgical and functional outcomes to CLP while providing the potential advantages of less blood loss and lower analgesic requirement. Thus, despite being more technically challenging, LESS pyeloplasty can be regarded as a minimally invasive approach for patients seeking fewer incisional scars.

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“…Kavoussi and Peters3 performed the first laparoscopic dismembered pyeloplasty in 1993. In an international multi-institutional review, LESS-P (Laparoendoscopic Single-Site Pyeloplasty) was found to have comparable results with conventional multiport laparoscopic surgery 4. Clots in the pelvicalyceal system or ureter can result from instrumentation, trauma or coagulopathy 5 6.…”

Section: Discussionmentioning

confidence: 99%

Recurrent clot anuria following laparoscopic pyeloplasty in a solitary functioning kidney: managing with double guide wire technique

et al. 2014

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Clot anuria in a solitary functioning kidney is an emergency situation. Haematuria with clot anuria in an early postoperative period represents a challenge, as treatment options are limited. Manipulation of the anastomotic site may lead to anastomotic disruption and urinoma while use of thrombolytic therapy poses the danger of increasing haematuria. We report a case of anuria due to clot retention in the upper tract following laparoscopic dismembered pyeloplasty in a solitary functioning kidney, managed successfully with double guide wire technique.

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Laparoendoscopic Single-site Pyeloplasty: Outcomes of an International Multi-institutional Study of 140 Patients

Cited by 21 publications

References 30 publications

Laparoendoscopic single‐site versus conventional laparoscopic pyeloplasty: A matched pair analysis

Laparoendoscopic single‐site versus conventional laparoscopic pyeloplasty: A matched pair analysis

Laparoendoscopic single site surgery versus conventional laparoscopy for transperitoneal pyeloplasty: A systematic review and meta-analysis

Recurrent clot anuria following laparoscopic pyeloplasty in a solitary functioning kidney: managing with double guide wire technique

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