Pyeloplasty techniques using minimally invasive surgery (MIS) in pediatric patients

Turrà, Francesco; Escolino, Maria; Farina, Alessandra; Settimi, Alessandro; Esposito, Ciro; Varlet, François

doi:10.21037/tp.2016.10.05

Cited by 14 publications

(11 citation statements)

References 35 publications

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“…Hematuria and urinary tract infec-tions (UTI) are also likely to be observed in patients with UPJO. Indications for surgical intervention in patients with UPJO include obstruction-related symptoms, impaired renal function, progressive deterioration of ipsilateral renal function, developing renal stones, infections, and hypertension (2,3).…”

Section: Introductionmentioning

confidence: 99%

Laparoscopic-Assisted Extracorporeal Pyeloplasty: A Minimally Invasive Approach to Pediatric Ureteropelvic Junction Obstruction

et al. 2018

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Background: Ureteropelvic junction obstruction (UPJO) is a common congenital anomaly in pediatrics that may require surgical intervention performed by open, laparoscopic-assisted, laparoscopic, or robotic-assisted fashion. Laparoscopic pyeloplasty hasn't become popular due to instrument or skill limitations. Laparoscopic-assisted pyeloplasty could be the first step towards a minimally invasive approach to UPJO in pediatrics. Methods: The current study was conducted on 60 infants with UPJO treated with either laparoscopic-assisted extracorporeal or open pyeloplasty. In our modified approach, the ureteropelvic junction was exposed and released laparoscopically and pulled out of the abdominal cavity and pyeloplasty was performed simply over a JJ stent. The second group was treated by conventional posterior lumbotomy approach. All patients were followed up after the operation at least for six months and the results were compared between the two groups. Results: Comparison of the pelvic anteroposterior diameter before and after the operation indicated a significant reduction after the operation in both groups. Diuretic scan after JJ catheter removal did not show signs of obstruction in almost all cases among both groups. Comparison of the postoperative complications revealed no significant differences between the two groups. The complication rate was also very low and almost the same in both groups. Conclusions: Full laparoscopic pyeloplasty demands advanced surgical skills and fine instruments, which made it time-consuming and less applicable widely. Laparoscopic-assisted pyeloplasty is more applicable while it showed acceptable results in the current study. The current approach is suggested as the first step toward MIS for UPJO in pediatrics.

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Section: Introductionmentioning

confidence: 99%

Laparoscopic-Assisted Extracorporeal Pyeloplasty: A Minimally Invasive Approach to Pediatric Ureteropelvic Junction Obstruction

et al. 2018

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“…A long learning curve is needed, especially for suturing and knotting. [4] In recent years, with the development of endoscopic technology, more experts have recognized the advantages of retroperitoneoscopic pyeloplasty, and more reports have been published; thus, this technique has gradually become one of the advanced methods for treatment. [16] However, the reports that have been published have mostly involved children older than 2 years, and less have been reported involving infants younger than 2 years.…”

Section: Discussionmentioning

confidence: 99%

“…[2] Hydronephrosis is the most common presentation of ureteropelvic junction obstruction (UPJO), which causes a reduction in urine flow from the renal pelvis into the ureter and is the most common cause of congenital hydronephrosis. [3,4] The other main causes of hydronephrosis include vesicoureteric junction obstruction (VUJ), posterior urethral valves (PUVs), and vesicoureteric reflux (VUR). [5] The treatment is dependent upon the cause and the severity of hydronephrosis; however, infants with mild UPJO may not need any surgical intervention but must undergo monitoring on a regular basis.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of the clinical value of retroperitoneal laparoscopic pyeloplasty in the treatment of ureteropelvic junction obstruction in infants

Zhang¹,

Li²,

Li³

et al. 2019

Medicine

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Retroperitoneal laparoscopic pyeloplasty (RLP) is 1 method for treating ureteropelvic junction obstruction (UPJO) in children, but reports are more common in children than in infants younger than 2 years old. The purpose of this study was to evaluate the clinical value of RLP for infants with UPJO.From January 2015 to December 2017, a retrospective analysis of 22 infants aged 2 to 24 (11.95 ± 6.00) months with UPJO who were treated with RLP in our hospital was performed. During the same period, 14 infants who underwent conventional transperitoneal laparoscopic pyeloplasty (TLP) were compared with those who underwent RLP. Postoperative recovery and complications, including bleeding, infection, urinary leakage and anastomotic stenosis, postoperative resumption of oral feeding, postoperative hospitalization time and surgical success rate were evaluated. Drainage and function were assessed with isotope scan at 6 months and later during the yearly follow-up and by intravenous urography (IVU) and mercaptoacetyltriglycine (MAG3) renography.Both groups underwent successful surgery. The operative time in the RLP group was 88 to 205 (120.59 ± 24.59) min, and there was no significant difference compared with the TLP group (P = .767). The estimated intraoperative blood loss was 2 to 10 (3.75 ± 1.59) ml, which was not significantly different between the 2 groups (P = .386). In the RLP group, the mean postoperative resumption of oral feeding was faster than that in the TLP group (3.55 ± 0.74 vs 5.50 ± 0.85 hour, P < .001), and the postoperative hospitalization time was shorter in the TLP group than in the RLP group (6.59 ± 0.50 vs 7.07 ± 0.47 day, P = .007 < .05). Follow-up lasted from 6 months to 3 years, and there was a significant reduction in postoperative hydronephrosis in both groups (P < .05, respectively).RLP is a safe procedure for infants. This procedure is associated with relatively little trauma, a quick recovery and good cosmetic effects. RLP also has the advantages of relatively little interference with the abdominal cavity and sufficient operating space; thus, this technique is worth promoting.

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“…Although pyeloplasty has been traditionally performed in an open fashion, minimally invasive approaches have gained popularity in the past two decades. Laparoscopic pyeloplasty (LP) has become a commonly accepted procedure that has comparable safety and success to open pyeloplasty, with the advantage of shorter hospital stays and more rapid recovery [5,6]. In many settings, minimally invasive options are favoured for this and many other conditions.…”

Section: Introductionmentioning

confidence: 99%

Meta‐analysis of retroperitoneal vs transperitoneal laparoscopic and robot‐assisted pyeloplasty for the management of pelvi‐ureteric junction obstruction

Chua

Ming

Kim³

et al. 2020

BJU International

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Objective To determine differences in perioperative outcomes between retroperitoneal and transperitoneal approaches for laparoscopic pyeloplasty (LP) to manage pelvi‐ureteric junction obstruction (PUJO) through a meta‐analysis of comparative studies. Methods A systematic search was performed in January 2020. Comparative studies were evaluated according to Cochrane Collaboration recommendations. Assessed outcomes included success and complication rates, conversion to open surgery, operative time (OT), length of hospital stay (LOS), estimated blood loss (EBL), analgesic requirements, regular diet resumption, and drain duration. Relative risk (RR) and standardised mean difference (SMD) with 95% confidence intervals (CIs) were extrapolated. Subgroup analyses were performed according to study design and techniques. International Prospective Register of Systematic Reviews (PROSPERO) number: CRD42020163303. Results A total of 18 studies describing 2007 cases were included. Overall pooled effect estimates did not show statistically significant differences between the approaches with regards to success rate (RR 0.99; 95% CI 0.97, 1.01), complications (RR 1.09; 95% CI 0.82, 1.45), OT (SMD 0.61; 95% CI −0.04, 1.26), LOS (SMD −0.30; 95% CI −0.63, 0.04), EBL (SMD −0.53; 95% CI −1.26, 0.21), or analgesic requirements (SMD −0.51; 95% CI −1.23, 0.21). Compared to the transperitoneal approach, retroperitoneal LP had a higher conversion rate (RR 2.40; 95% CI 1.23, 4.66); however, patients resumed diets earlier (SMD −2.49; 95% CI −4.17, −0.82) and had shorter drain duration (SMD −0.31; 95% CI −0.57, −0.05). Conclusion The evidence suggests that there are no significant differences in success rate, OT and complications between transperitoneal and retroperitoneal LP. Conversion rates are higher with the retroperitoneal approach; however, return to diet occurs faster and drain duration is shorter when compared to the transperitoneal approach.

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Pyeloplasty techniques using minimally invasive surgery (MIS) in pediatric patients

Cited by 14 publications

References 35 publications

Laparoscopic-Assisted Extracorporeal Pyeloplasty: A Minimally Invasive Approach to Pediatric Ureteropelvic Junction Obstruction

Laparoscopic-Assisted Extracorporeal Pyeloplasty: A Minimally Invasive Approach to Pediatric Ureteropelvic Junction Obstruction

Evaluation of the clinical value of retroperitoneal laparoscopic pyeloplasty in the treatment of ureteropelvic junction obstruction in infants

Meta‐analysis of retroperitoneal vs transperitoneal laparoscopic and robot‐assisted pyeloplasty for the management of pelvi‐ureteric junction obstruction

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