Yonsei Med J.  2013 Jan;54(1):197-203. 10.3349/ymj.2013.54.1.197.

Transmesocolic Approach for Left Side Laparoscopic Pyeloplasty: Comparison with Laterocolic Approach in the Initial Learning Period

• Han HH
• Ham WS
• Kim JH
• Hong CH
• Choi YD
• Han SW
• Chung BH

• KMID: 1776938
• DOI: http://doi.org/10.3349/ymj.2013.54.1.197

Abstract

PURPOSE
To evaluate the outcome of transmesocolic (TMC) laparoscopic pyeloplasty compared with conventional laterocolic procedure for surgeons with limited experience.
MATERIALS AND METHODS
We started laparoscopic pyeloplasty for ureteropelvic junction obstruction in 2009. Since then, 21 patients of left side disease have undergone this surgery in our institution. To access the left ureteropelvic junction, we used the conventional laterocolic approach in 9 patients, while the transmesocolic approach was used in the remaining 12 patients, and perioperative results and follow-up data were then compared.
RESULTS
The mean operative time using the transmesocolic approach was significantly shorter than the conventional laterocolic approach (242 vs. 308 min, p=0.022). Furthermore, there was no complication or open conversion. Postoperative pain was significantly decreased in the TMC group (2.8 vs. 4.0 points, measured using the visual analogue scale on the first postoperative day, p=0.009). Postoperative complications were encountered in two patients. All patients were symptom-free after 1 year of follow-up, and radiologic success rates for each group were 92 and 89%, respectively.
CONCLUSION
Direct exposure of the ureteropelvic junction via the mesocolon saves time during the colon mobilization procedure. The approach is safe and feasible even for surgeons with limited experience, and has success rates similar to those of the conventional laterocolic approach.

Keyword

Hydronephrosis; laparoscopy; surgical procedures; minimally invasive; ureter; ureteral obstruction

MeSH Terms

Adolescent
Adult
Aged
Child
Child, Preschool
Colon/surgery
Disease-Free Survival
Female
Humans
Infant
Kidney/*surgery
Kidney Pelvis/*surgery
Laparoscopy/*methods
Male
Middle Aged
Pain, Postoperative
Postoperative Period
Reconstructive Surgical Procedures/methods
Time Factors
Ureter/surgery
Ureteral Obstruction/surgery
Urologic Surgical Procedures/*methods
Young Adult

Figure

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  Fig. 1 The mesenterocolic space, with landmarks (dotted line: incision line).

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  Fig. 2 (A) Transmesocolic approach. (B) Resection of pelvis and spatulation of ureter. (C) Anastomosis. (D) Anastomosis completed.

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