V1205: Transmesocolic Approach: Faster and Safe for Laparoscopic Surgery on the Left Side

Andreoni, Cássio; Gattás, Nelson; Araujo, Mardhen; Ortiz, Valdemar; Srougi, Miguel; Paulo, Siio

doi:10.1016/s0022-5347(18)39168-7

Cited by 6 publications

(9 citation statements)

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“…Conversely, on the left side the standard technique requires the mobilization of the descending colon. To avoid this surgical step, a direct transperitoneal approach to the left PUJ may be considered [11,12].…”

Section: Introductionmentioning

confidence: 99%

Transperitoneal left laparoscopic pyeloplasty with transmesocolic access to the pelvi‐ureteric junction: technique description and results with a minimum follow‐up of 1 year

et al. 2008

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OBJECTIVES To describe and evaluate the safety and outcome of transperitoneal left laparoscopic pyeloplasty (TLLP) with a direct approach to the pelvi‐ureteric junction (PUJ) through the mesentero‐colic space, which avoids mobilization of the descending colon. PATIENTS AND METHODS From March 2005 to June 2006, 18 consecutive patients underwent TLLP with direct access. For each patient age, gender, body mass index (BMI), hospital stay, skin‐to‐skin operative time, time from incision of the posterior peritoneum to dissection of the PUJ, blood loss, time to resumption of oral intake and complications were recorded. Statistical analysis was used to assess whether the body habitus (BMI <25 kg/m2 or >25 kg/m2) affected the outcomes. RESULTS There were no complications during or after surgery and no conversions to open surgery were needed. The mean (sd) time to resumption of oral intake was 1.36 (0.5) days. The mean hospital stay was 3.3 (0.67) days and the mean follow‐up was 17.4 (4.7) months. There was no statistical difference between patients with BMI higher or lower than 25 kg/m2 (P = 0.42). The success rate at 1 year after surgery was 100%. CONCLUSION TLLP with direct access to the PUJ through the mesentero‐colic space is a safe and effective technique. This approach should be considered for all patients with left primary PUJ obstruction who are eligible for a LP and especially for slim patients or patients with a large renal pelvis.

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Section: Introductionmentioning

confidence: 99%

Transperitoneal left laparoscopic pyeloplasty with transmesocolic access to the pelvi‐ureteric junction: technique description and results with a minimum follow‐up of 1 year

et al. 2008

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“…[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.…”

Section: Discussionunclassified

“…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.…”

Section: Robot Yardımlı Transmezokolikunclassified

Robot Assisted Laparoscopic Transmesocolic Right Pyeloplasty: Case Report

Demirer¹,

Fırat²,

Başal³

et al. 2015

Turkiye Klinikleri J Urology

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“…Andreoni et al . [6] and Cisek et al . [7] published the first cases of TM laparoscopic pyeloplasty in 2004.…”

Section: Discussionmentioning

confidence: 99%

“…Transmesocolic (TM) exposure has been suggested as an alternative method of accessing the area in cases where the renal pelvis is obviously bulged on inspection and the colon mesentery is translucent [6–8]. We developed this approach independently at our centre in 2003 and observed its usefulness for easy access to the PUJ, saving operating time and apparently leading to more rapid recovery.…”

Section: Introductionmentioning

confidence: 99%

Prospective clinical trial to compare standard colon‐reflecting with transmesocolic laparoscopic pyeloplasty

et al. 2012

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Study Type – Therapy (case series) Level of Evidence 4 What's known on the subject? and What does the study add? Laparoscopic pyeloplasty has replaced open pyeloplasty as the new standard of care and we, among others, have even proven its applicability to redo surgery. The focus is now on limiting morbidity. One technical modification to this end is transmesocolic (TM) exposure of the PUJ. This randomized study pinpoints the objective benefits of TM exposure of the PUJ compared with standard colon reflection, and its results showed a 23% conservation in operating time. OBJECTIVE To compare the efficacy and safety of colon‐reflecting (CR) and transmesocolic (TM) laparoscopic pyeloplasty approaches in a prospective randomized non‐selective setting. PATIENTS AND METHODS Excluding only those patients with a history of abdominal surgery, all consenting patients scheduled for laparoscopic pyeloplasty of left‐sided pelvi‐ureteric junction (PUJ) obstruction between December 2004 and November 2007 were randomized into one of two groups: laparoscopic pyeloplasty using the standard CR approach or laparoscopic pyeloplasty through the TM aperture. All patients underwent dismembered repair by a single expert and were followed by diuretic renogram and urography at 4 months postoperatively and by annual diuretic renogram thereafter. Four discrete task phases were timed for comparison: trochar to PUJ, dismembering and spatulation, stenting and anastomosis. RESULTS Sixty‐four patients were randomized into two groups, TM or CR, with 32 patients in each. The groups were similar, with no significant difference in sex, age, initial renal function or body mass index. Forty‐seven patients were ≤15 years old. The mean (sd) operating time was 23% shorter in the TM group, owing mostly to the much shorter trochar to PUJ phase (5.0 [3.2] min in the TM group vs 35.8 [10.3] in the CR group; P < 0.001). The mean hospitalization time was shorter in the TM group than in the CR group (2.9 vs 3.6 days; P < 0.001). Thirty‐one of 32 patients in each group (96.9%) achieved a durable cure. CONCLUSION Transmesocolic exposure of left‐sided PUJ obstruction is superior to standard CR exposure, in that it saves anaesthesia time, hospitalization time and has lower morbidity with no compromise in efficiency, and could be considered as the new standard approach.

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V1205: Transmesocolic Approach: Faster and Safe for Laparoscopic Surgery on the Left Side

Cited by 6 publications

References 0 publications

Transperitoneal left laparoscopic pyeloplasty with transmesocolic access to the pelvi‐ureteric junction: technique description and results with a minimum follow‐up of 1 year

Transperitoneal left laparoscopic pyeloplasty with transmesocolic access to the pelvi‐ureteric junction: technique description and results with a minimum follow‐up of 1 year

Robot Assisted Laparoscopic Transmesocolic Right Pyeloplasty: Case Report

Prospective clinical trial to compare standard colon‐reflecting with transmesocolic laparoscopic pyeloplasty

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