Standard vs mini‐laparoscopic pyeloplasty: perioperative outcomes and cosmetic results

Abstract

What ' s known on the subject? and What does the study add? New techniques and instrumentation in laparoscopy including the use of ' single-port ' devices and natural orifi ce transluminal endoscopic surgery have been proposed to reduce the invasiveness of these procedures. The introduction of small laparoscopic instruments ( < 3 mm) continues to further the fi eld. To date, mini-laparoscopic instruments have been used in many urological procedures, e.g. pyeloplasty in the paediatric population. However, data of pure mini-laparoscopic pyeloplasty (mLP) for the treatment of pelvi-ureteric junction obstruction in the adult population are lacking.In a selected adult population mLP is feasible and safe. Perioperative and 1-year functional results are comparable with those of standard LP, while cosmetic results of mLP are more appreciated by the patients.

Robot-assisted laparoscopic pyeloplasty: current status and future directions

“…A recent trend in LP has been the introduction of "mini laparoscopic pyeloplasty" or mLP, which utilizes 3.5 mm working trocars and a 5 mm camera port. Published results in both adults 23 and pediatric patients 24 show no significant difference in operative duration or estimated blood loss, as well as similar complication rates for LP and mLP. In the adult series, mLP was in fact associated with a shorter hospital stay and patients were more satisfied in the mLP group.…”

Contemporary Urologic Minilaparoscopy: Indications, Techniques, and Surgical Outcomes in a Multi-Institutional European Cohort

“…Although the present series is devoid of data about patient satisfaction and scar assessment, Fiori and colleagues recently evaluated cosmetic outcomes in patients undergoing minilaparoscopic and standard pyeloplasty, by administering 3 months postoperatively a standardized questionnaire. 10 The authors found that patients who underwent the minilaparoscopic approach were significantly more satisfied with their cosmetic results than those who received standard laparoscopic pyeloplasty. Besides the comparison between ML and standard laparoscopy, it also remains to be determined the comparison between ML and LESS.…”

“…A fourth 3.5-mm trocar, placed just below the xiphoid, was used as a liver retractor in case of right-sided procedures. 10 For the retroperitoneal approach ( Fig. 2c), a retroperitoneal tunnel was created through a 6 mm skin incision below the inferior edge of the 12th rib.…”

“…7 In urology, however, small case series and case-control studies have been reported so far. [10][11][12] To our knowledge, this is the first large cohort reporting the outcomes of contemporary ML and providing an overview of the current applications in our surgical specialty.…”

“…8,9 In urology, evidence supporting ML has been limited to small case series or case-control studies from selected centers with laparoscopic expertize. [10][11][12] Thus, more robust analyses of larger samples are desirable to corroborate positive findings from early series.…”