ABSTRACT
OBJECTIVES: Laparoscopic pyeloplasty (LP) is the treatment of choice for ureteropelvic junction obstruction (UPJO). We present the 3-trocars LP technique with several considerations and practical advices. METHODS: Several maneuvers to optimize exposure and simplifying the implementation of the operation were showed. A total of thirteen patients with UPJO and criteria for surgical treatment were included, and were operated using the 3 trocars LP technique. Demographic data, perioperative and follow-up were collected retrospectively. RESULTS: Mean operative time was 132 minutes. No conversion to open surgery was registered and additional trocar insertion was not required. Neither perioperative complications nor postoperative complications were reported. Three patients needed ureteral stenting preoperatively for pain. Five patients required flexible nephroscopy with CO2 for extraction of calyceal stones. The pain was controlled in all cases. CONCLUSIONS: The LP is a feasible and safe technique for the surgical correction of UPJO, and maneuvers presented in this study simplify the procedure and may be applied in other laparoscopic procedures.
Subject(s)
Kidney Pelvis/surgery , Laparoscopy/methods , Ureteral Obstruction/surgery , Adolescent , Adult , Female , Humans , Male , Middle Aged , Retrospective Studies , Young AdultABSTRACT
OBJETIVO: La Pieloplastia Laparoscópica (PL) es el tratamiento de elección de la Obstrucción de la Unión Pieloureteral (OUPU). Presentamos la técnica ilustrada de PL con tres trócares con refinamientos y consejos prácticos. MÉTODOS: Se describen varias maniobras paso a paso, para optimizar la exposición y simplificar la ejecución de la cirugía. Un total de trece pacientes con OUPU con criterios para tratamiento quirúrgico fueron incluidos. Todos ellos fueron operados de PL empleando 3 trócares. Los datos demográficos, perioperatorios y de seguimiento fueron recolectados de manera retrospectiva. RESULTADOS: El tiempo operatorio promedio fue de 132 minutos, no hubo conversión a cirugía abierta ni se requirió inserción de trocar adicional en ninguno de los casos. No se reportaron complicaciones perioperatorias ni post-operatorias. Tres casos requirieron inserción de catéter doble J previamente por dolor. Cinco pacientes requirieron nefroscopia flexible con CO2 para la extracción de litiasis caliciales. Todos los casos presentaron desaparición del dolor. Conlcuisones: La PL con tres trocares es una técnica factible y segura en la corrección quirúrgica de la OUPU, y las maniobras presentadas en este estudio simplifican el procedimiento y pueden tener aplicación en otras intervenciones laparoscópicas
OBJECTIVES: Laparoscopic pyeloplasty (LP) is the treatment of choice for ureteropelvic junction obstruction (UPJO). We present the 3-trocars LP technique with several considerations and practical advices. METHODS: Several maneuvers to optimize exposure and simplifying the implementation of the operation were showed. A total of thirteen patients with UPJO and criteria for surgical treatment were included, and were operated using the 3 trocars LP technique. Demographic data, perioperative and follow-up were collected retrospectively. RESULTS: Mean operative time was 132 minutes. No conversion to open surgery was registered and additional trocar insertion was not required. Neither perioperative complications nor postoperative complications were reported. Three patients needed ureteral stenting preoperatively for pain. Five patients required flexible nephroscopy with CO2 for extraction of calyceal stones. The pain was controlled in all cases. CONCLUSIONS: The LP is a feasible and safe technique for the surgical correction of UPJO, and maneuvers presented in this study simplify the procedure and may be applied in other laparoscopic procedures
Subject(s)
Humans , Female , Adolescent , Young Adult , Adult , Middle Aged , Aged , Laparoscopy/instrumentation , Laparoscopy/methods , Laparoscopy , Constriction, Pathologic/complications , Constriction, Pathologic/pathology , Constriction, Pathologic , Surgical Instruments , Low Back Pain/pathology , Lithiasis/diagnosis , Lithiasis/surgery , Lithiasis , Catheters , Ultrasonography/instrumentation , Ultrasonography/methods , Ultrasonography , Urography/instrumentation , Urography/methods , Urography , Retrospective StudiesABSTRACT
OBJECTIVES: To evaluate the result of retrograde intrarenal surgery (RIRS) assisted by flexible ureterorenoscopy (FURS) and Holmium laser in the treatment of lithiasis within calyceal diverticula as a minimally invasive therapeutic option. METHODS: We retrospectively evaluated 11 cases of symptomatic lithiasis within calyceal diverticula treated between January 2010 and December 2011. We defined treatment success as absence of residual stones and absence/disappearance of symptomatology over the course of follow-up. We describe the RIRS technique and maneuvers for locating the diverticulum, opening the neck, and fragmenting intradiverticular lithiasis. RESULTS: The most frequently experienced symptom was flank pain (72.7%). The size of the lithiasis treated ranged from 7-20 mm. The overall success rate of RIRS was approximately 73% (absence of lithiasis and disappearance of symptoms) with an average follow-up of 13.3 months. Three cases were not solved by RIRS (2 due to unsuccessful location of the neck, 1 due to persistence of lithiasis and symptoms) . Cases of unsuccessful location were treated with laparoscopic surgery. CONCLUSION: RIRS assisted by FURS and Holmium laser is an effective and minimally invasive procedure for the treatment of lithiasis in the interior of the calyceal diverticulum. This treatment's efficacy improves upon the results from ESWL (extracorporeal shock wave lithotripsy( and equals that of the percutaneous method, exhibiting a lower rate of complications.
Subject(s)
Diverticulum/surgery , Kidney Diseases/surgery , Kidney/abnormalities , Kidney/surgery , Lithiasis/surgery , Adult , Diverticulum/complications , Endoscopy , Female , Humans , Lithiasis/complications , Male , Middle AgedABSTRACT
OBJETIVO: Evaluar el resultado de la cirugía retrograda intrarenal (CRIR) con uso de ureterorrenoscopio flexible (URSF) y láser Holmium en el tratamiento de la litiasis en el interior del divertículo calicial como una opción terapéutica mínimamente invasiva. MÉTODOS: Evaluamos retrospectivamente 11 casos de litiasis sintomáticas en el interior de divertículo calicial tratadas entre enero de 2010 y Diciembre de 2011. Definimos éxito del tratamiento: ausencia de restos litiásicos residuales y ausencia/desaparición de la sintomatología a lo largo del seguimiento. Describimos la técnica de CRIR y maniobras para la localización del divertículo, apertura del cuello y fragmentación de litiasis intradiverticular. RESULTADOS: El síntoma de presentación más frecuente fue dolor en el flanco (72,/%). El tamaño de litiasis tratada osciló entre 7-20 mm, El éxito global de CRIR fue de un 73% (ausencia litiasis y desaparición síntomas) con media de seguimiento de 13,3 meses. En 3 casosla CRIR no fue resolutiva (2 por no localización del cuello, 1 por persistencia de litiasis y sintomatología). Los casos de no localización se trataron con cirugía laparoscópica. CONCLUSIÓN: La CRIR con uso de URSF y láser holmium es un procedimiento efectivo y mínimamente invasivo en el manejo de la litiasis en el interior del divertículo calicial
OBJECTIVES: To evaluate the result of retrograde intrarenal surgery (RIRS) assisted by flexible ureterorenoscopy (FURS) and Holmium laser in the treatment of lithiasis within calyceal diverticula as a minimally invasive therapeutic option. METHODS: We retrospectively evaluated 11 cases of symptomatic lithiasis within calyceal diverticula treated between January 2010 and December 2011. We defined treatment success as absence of residual stones and absence/disappearance of symptomatology over the course of follow-up. We describe the RIRS technique and maneuvers for locating the diverticulum, opening the neck, and fragmenting intradiverticular lithiasis. RESULTS: The most frequently experienced symptom was flank pain (72.7 %). The size of the lithiasis treated ranged from 7-20 mm. The overall success rate of RIRS was approximately 73% (absence of lithiasis and disappearance of symptoms) with an average follow-up of 13.3 months. Three cases were not solved by RIRS (2 due to unsuccessful location of the neck, 1 due to persistence of lithiasis and symptoms). Cases of unsuccessful location were treated with laparoscopic surgery. CONCLUSION: RIRS assisted by FURS and Holmium laser is an effective and minimally invasive procedure for the treatment of lithiasis in the interior of the calyceal diverticulum. This treatments efficacy improves upon the results from ESWL [extracorporeal shock wave lithotripsy] and equals that of the percutaneous method, exhibiting a lower rate of complications
