Laparoscopic management of ureteropelvic junction obstruction by division of anterior crossing vein and cephalad relocation of anterior crossing artery.

PURPOSE: We report our experience with laparoscopic management of ureteropelvic junction (UPJ) obstruction by division of the anterior crossing vein and cephalad relocation of the anterior crossing artery. PATIENTS AND METHODS: We used this laparoscopic approach in four male and six female patients with UPJ obstruction associated with anterior crossing vessels. The mean age of the patients was 31.9 years (range 14-59 years). The obstruction was present on the right side in four and on the left side in six patients. Using a transperitoneal approach, the crossing vein was divided, while the crossing artery was preserved, relocated cephalad, and fixed to the peripelvic tissues with metal clips or sutures. Because a grossly normal appearance of the UPJ and upper ureter together with proper pyeloureteral peristalsis and complete renal pelvic emptying were observed intraoperatively, dismembered pyeloplasty was not performed in any of these patients. Diuretic renography and intravenous urography were performed 3, 6, and 12 months postoperatively. RESULTS: The mean operative duration was 140 minutes (range 100-170 minutes). The mean hospital stay was 2.9 days (range 2-5 days), and the mean follow-up was 9.1 months (range 3-22 months). Diuretic renography revealed absence of obstruction in all patients, and intravenous urography showed considerable improvement of the hydronephrosis. CONCLUSION: Select cases of UPJ obstruction associated with anterior crossing vessels seem to be amenable to laparoscopic management by division of the crossing vein and cephalad relocation of the crossing artery. Laparoscopy as a minimally invasive approach may offer a better opportunity to evaluate the role of anterior crossing vessels in UPJ obstruction.

Laparoscopic partial nephrectomy for tumours >4 cm compared with smaller tumours: perioperative results.

OBJECTIVE: The use of laparoscopic partial nephrectomy (LPN) in patients with tumours >4 cm remains to be further evaluated. We report our experience with LPN in tumours >4 cm compared with tumours ≤4 cm. MATERIALS AND METHODS: This is a retrospective study of data from all LPN patients operated from 2003 to 2008. Inclusion criteria were a single organ confined contrast enhancing mass/Bosniac III-IV cyst. Hospital admission records were used to extract operative and follow-up data. Patients were grouped into group A: ≤4 cm (32 patients, 53% of total), and group B: >4 cm (28 patients, 47% of total). RESULTS: A total of 60 patients (mean ± SD age, 47.4 ± 13.4 years; M/F, 36/24) were included. Mean ± SD tumour size was 31.5 ± 7.3 mm and 51.6 ± 10.9 mm in groups A and B, respectively. (P < 0.001) Malignant pathology was present in 22 (69%) and 16 patients (57%) in groups A and B, respectively. (P > 0.05) There was no statistically significant difference in age, gender, pre-operative creatinine, estimated glomerular filtration rate (eGFR), and other investigated pre-operative characteristics between study groups. (all P > 0.05) Nor any difference was observed regarding operative and pathologic (warm ischaemia time, operation duration, transfusion, positive margins, and malignant histology) as well as post-operative variables (re-hospitalization, post-operative complications, hospital stay, or eGFR changes). CONCLUSION: The results of this study supports the feasibility and comparability of operative and post-operative early complications for LPN when applied to tumours >4 cm in selected patients compared with tumours ≤4 cm.