Transmesocolic Approach to Laparoscopic Pyeloplasty: Our 8-Year Experience

Abstract

Open pyeloplasty is the gold standard in the treatment of congenital ureteropelvic junction obstruction. Several reports have shown that laparoscopic pyeloplasty produces comparable results. In this paper, we report a retrospective study of the transmesocolic approach to the left ureteropelvic junction obstruction in 26 patients. As colon mobilization is avoided, the field remains fairly clear. This direct approach also saves time and is least invasive. One patient was lost for follow-up, and 1 patient is awaiting a renogram. Among the remaining 24 patients, 22 patients had improved drainage (IVU or isotope renogram), and 2 of the patients had stable renal function.

Transmesocolic laparoscopic pyeloplasty in children: A standard approach for the left-side repair

“…Different anatomical conditions on the left side, where the splenic flexure of the colon is placed more cranially, led to introduction of the anterior transmesocolic approach [19,20]. Since then, this approach has gained support in a few series of paediatric, mostly selected patients [15,21,22]. In this article, we present anatomical and technical details and the long-term outcome of this transmesocolic approach in the left-side laparoscopic pyeloplasty in comparison with the conventional laterocolic right-side repair in a large series of consecutive children and adolescents.…”

Robot Assisted Laparoscopic Transmesocolic Right Pyeloplasty: Case Report

“…ile aynı dönemde Ramalingam ve ark., çocuk ve erişkinlerdeki tecrübelerinde benzer sonuçlar bildirmişlerdir. 11 Daha sonra yayımlanan diğer ça-lışmalarda; TMC yönteminin laterokolik yönteme göre benzer başarı oranı (>%90) ve komplikasyon oranına sahip olmakla birlikte hospitalizasyon ve ameliyat süresini anlamlı derecede kısalttığı rapor edilmiştir. [13][14][15][16][17] Standart laparoskopiye benzer şekilde TMC yaklaşımla RYLP de tanımlanmıştır.…”

“…[7][8][9][10][11][12][13][14][15][16][17]23 Bu yaklaşım birçok çalışmada sol ÜPBD olan hastalara uygulanmıştır. [7][8][9][10][11][12][13][14][15][16][17]23 Çünkü sol kolonik fleksura (splenik) sağ kolonik (hepatik) fleksura göre daha süperiorda ve sol ÜPB sol kolon mezenteri maskesi altındadır. Sol ÜPB mezokolon avasküler alanından insizyonla nispeten daha kolay ulaşılmaktadır.…”

“…2,5,6 Kolonun medialize edilmesini gerektiren standart transperitoneal yaklaşıma göre son yıllarda kullanımı gittikçe yaygınlaşan transmezokolik (TMC) yaklaşım ameliyat süresini kısaltmaktadır. [7][8][9][10][11][12][13][14][15][16][17] Bu çalışmada, sağ ÜPBD'li 25 yaşındaki eriş-kin erkek olguda yapılan TMC RYLP uygulaması sunulmuştur.…”

A Comparison of Continuous and Interrupted Suturing in Laparoscopic Pyeloplasty

“…The proximal ureter was mobilized, with care taken to preserve the vascularity and crossing vessels if present. In patients with left UPJ obstruction, if the vascular pattern of the mesocolon was conducive 9 and if the fat in the mesentery was minimal, the UPJ was dissected using the transmesocolic approach. The UPJ was dismembered and the ureter spatulated laterally using scissors without using diathermy.…”