Feasibility and safety of retroperitoneal laparoendoscopic single-site dismembered pyeloplasty: a clinical report of 10 cases.

ABSTRACT

OBJECTIVE: To retrospectively review our experience with respect to evaluating the feasibility and safety of laparoendoscopic single-site (LESS) dismembered pyeloplasty for ureteropelvic junction obstruction (UPJO) through a retroperitoneal approach. PATIENTS AND METHODS: Between March 2011 and January 2012, 10 consecutive patients underwent LESS retroperitoneoscopic dismembered pyeloplasty performed by one experienced laparoscopic surgeon at our institution. A single-port access was inserted through a 2.5-cm transverse skin incision below the 12th rib along the midaxillary line. Standard steps of the multisite retroperitoneoscopic Anderson-Hynes dismembered pyeloplasty technique using conventional instruments or a combination of conventional and bent laparoscopic instruments were performed. Follow-up studies were conducted by intravenous urography (IVU), diuretic renal scan, and renal ultrasonography. RESULTS: LESS retroperitoneoscopic dismembered pyeloplasty was successful in 9 patients, whereas 1 required four-port retroperitoneoscopic conversion because of difficulties in remaining in the retroperitoneal space due to a peritoneal tear during the procedure. The mean operative time was 148.4 minutes (range, 103-210 minutes). The mean estimated blood loss was 31 mL (range, 10-70 mL), and the mean postoperative hospital stay was 5.7 days (range, 3-13 days). Intraoperative complications were limited to the one case of peritoneal tear. An aberrant crossing vessel was noted in 4 patients, and transposition was not required in these patients. Urine leakage occurred in 1 patient postoperatively and was successfully treated by conservative management. The mean follow-up period was 6.2 months (range, 5-10 months). Satisfactory drainage with decreased hydronephrosis on IVU, diuretic renal scan, and renal ultrasonography was observed in all cases at the 3-month imaging studies. CONCLUSIONS: In experienced hands, LESS retroperitoneoscopic dismembered pyeloplasty is a feasible and safe alternative for correcting UPJO, although it remains technically challenging. The long-term outcome awaits further studies.