Recent advances in urologic surgical techniques for pyeloplasty

Abstract

Pyeloplasty is one of the most common urological reconstructive interventions. Since the presentation of the first open pyeloplasty by Anderson and Hynes in 1949, the management of ureteropelvic junction obstruction has dramatically developed. The most immense progress was made in the 1990s with the introduction of laparoscopy. A multitude of new minimal surgical techniques have been introduced since then. In the last few years, the innovations were based on refinement of already-existing techniques and technology. With this aim, single-port surgery, three-dimensional vision for laparoscopy, robotic technology, and alternative techniques for creating the anastomosis-like fibrin glue have been introduced. This unsystematic review is timely, and the scientific interest is to present and discuss some of the latest advances in surgical techniques and different approaches for the intra- and post-operative management in pyeloplasty. To the best of our knowledge, this is the only review looking at the recent advances in urological surgical techniques for pyeloplasty during the last few years with a focus on new technology and surgical techniques.

Minimal Invasive Treatment in Pelvic-Ureteric Junction Obstruction: A Comprehensive Review

“…In 1949, Anderson and Hynes described open dismembered pyeloplasty technique to correct PUJO. 10 This technique has been shown to be very versatile, safe and effective, resulting in 95% success rate. 11 , 12 To date, the same technique is still regarded as gold standard for pyeloplasty, especially in infants younger than 1 year.…”

“…In 1990s, Schuessler et al and Peters et al pioneered the laparoscopic approach in performing dismembered pyeloplasty. 10 The most recent development in PUJO surgical management is percutaneous endopyeloplasty and robotic surgery, which were first introduced in 2002. 14 , 15 The historical development of PUJO treatment is summarised in Figure 1 , and will be discussed in more detail under subsequent headings.…”

“…This procedure reduced the common surgical-site related complications such as bleeding and infection, with a better cosmetic result. 10 Stein et al and Tugcu et al observed that laparo-endoscopic single-site surgery (LESS) provided excellent satisfaction for patients in terms of wound scars. 36 , 37 Nonetheless, the lack of triangulation in LESS may lead to clashing of the instruments.…”

“… 38 Another technique utilising the LESS principle is the single-incision triangulated umbilical surgery (SITUS), which combines the classic laparoscopy principles with the minimal invasiveness of LESS. 10 Liu et al observed that the single-port system LESS had a similar success rate, postoperative complication and length of hospital stay to conventional multi-port procedure. However, the operating time was significantly shorter using the multi-port laparoscopy.…”

<p>Comparison of Safety, Efficacy and Outcomes of Robot Assisted Laparoscopic Pyeloplasty vs Conventional Laparoscopy</p>

“…43 According to the faculty review by Mendrek et al, no clear consensus exists about statistically significant differences between RALP and LP in terms of operative time and complication rates, while the two techniques are statistically equivalent regarding hospital readmissions and success rate. 44…”