Korean J Urol.  2009 Oct;50(10):996-1002.

Experience with Laparoscopic Pyeloplasty, Including Robot-Assisted Laparoscopic Surgery, for Ureteropelvic Junction Obstruction

• Kim SC
• Kang T
• Park H

Abstract

PURPOSE
Laparoscopic pyeloplasty was developed as a minimally invasive alternative to an open procedure for the treatment of ureteropelvic junction (UPJ) obstruction. We present our experience with the first 30 consecutive cases of laparoscopic pyeloplasty performed at our institution.
MATERIALS AND METHODS
We studied 30 patients with ureteropelvic junction obstructions who underwent laparoscopic pyeloplasty between March 2004 and March 2009. Of the 30 patients, 5 patients underwent robot-assisted laparoscopic pyeloplasty (RALP) since April 2008. Patients were divided into 4 groups according to operative procedure: group 1, early laparoscopic pyeloplasty-dismembered (E/LP-D, n=9); group 2, late laparoscopic pyeloplasty-dismembered (L/LP-D, n=9); group 3, laparoscopic pyeloplasty-Fenger's method (LP-F, n=7); and group 4, RALP (n=5).
RESULTS
The mean age of the patients was 34.0+/-12.8 years (range, 17-61 years). A crossing vessel was present in 37.9% of cases. Mean follow-up was 30+/-14 months (range, 11-62 months). Mean operative time was 267.3+/-78.7 minutes (range, 154-460 minutes), and the average length of the postoperative hospital stay was 4.6+/-1.6 days (range, 3-10 days). There were no intraoperative complications or transfusion. The success rate was 73.3%. The success rates of E/LP-D, L/LP-D, LP-F, and RALP were 6/9 (66.7%), 7/9 (77.8%), 5/7 (71.4%), and 4/5 (80%), respectively, without significant difference (p>0.05). Operation time and length of hospital stay were shorter in the L/LP-D group than in the E/LP-D group.
CONCLUSIONS
Laparoscopic pyeloplasty may be an alternative treatment for an ureteropelvic junction obstruction, but the technical complexity of the procedure has made it difficult for many surgeons to adopt. RALP is a technically feasible management option for UPJ obstruction.

Keyword

Laparoscopy; Ureteral obstruction; Robotics

MeSH Terms

Follow-Up Studies
Glycosaminoglycans
Humans
Intraoperative Complications
Laparoscopy
Length of Stay
Operative Time
Robotics
Ureteral Obstruction
Glycosaminoglycans

Figure

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  Fig. 1. Port placement in laparoscopic pyeloplasty. (A) Laparoscopic pyeloplasty: 5 mm left working port (W) & 12 mm right working port (W) midway between the umbilicus and the xiphoid process, at least 5 cm below the umbilicus in the midline, and 12 mm camera port (C) at the umbilicus. (B) Robot-assisted laparoscopic pyeloplasty: two 8 mm working ports (W) midway between the umbilicus and the xiphoid process, pararectally below the level of the umbilicus; a 12 mm camera port (C) at the umbilicus; and a 12 mm assistant port (A) at least 5 cm below the umbilicus in the midline.

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  Fig. 2. The change in T1/2 in 99mTC-MAG3 for three patients who had no symptoms preoperatively. In all three patients, T1/2 improved within 2 years after surgery.

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  Fig. 3. Recurrence-free survival. Of the 8 cases with failure, 7 cases failed before 10 months. Robot-assisted laparoscopic pyeloplasty showed the highest success rate with 80%, followed by late laparoscopic pyeloplasty-dismembered with 77.8%, laparoscopic pyeloplasty-Fenger with 71.4%, and early laparoscopic pyeloplasty-dismembered with 66.7%, but these rates were not significantly different (p＞0.05). Because the follow-up of robot-assisted laparo-scopic pyeloplasty was short, it was hard to compare to laparo-scopic surgery. RALP: robot assisted laparoscopic pyeloplasty, E/LP-D: early laparoscopic pyeloplasty-dismembered type, L/LP-D: late laparoscopic pyeloplasty-dismembered type, LP-F: laparoscopic pyeloplasty-Fenger’s type

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