Extracorporeal ureter handling during laparoscopic pyeloplasty: Tips and tricks for beginners

Mikhail Enikeev, Jeffrey Gahan, Ofer Yossepowitch, Leonid Rapoport, Vagarshak Grigoryan, Abdusalam Abdusalamov, Mikhail Lobanov, Leonid Chuvalov, Mark Taratkin, Stanislav Ali, Margarita Gaas, Dmitry Enikeev, Petr Glybochko

Research output: Contribution to journalArticle

Abstract

Introduction Laparoscopic preparation of the ureter is a challenging part of upper urinary tract reconstruction, due to limited depth perception provided by the camera and lack of wristed motion of most laparoscopic instruments needed for adequate spatulation and scar tissue removal. One solution has been to perform the more difficult portions of the surgery in an extracorporeal manner. A hybrid intra-corporeal-extracorporeal approach to upper tract ureteral reconstruction facilitates ureteral preparation at the stage of mastering the technique. Material and methods This retrospective study included 100 patients with primary ureteropelvic junction obstruction, who underwent laparoscopic pyeloplasty from 2014 to 2017. The patients were stratified into 2 groups: those who underwent conventional laparoscopic surgery and those who were managed with the hybrid approach. For the hybrid approach, externalizing the ureter to skin level required additional mobilization of the upper urinary tract. Results A total of 47 patients underwent conventional laparoscopic pyeloplasty and 53 – hybrid surgery. The maximum body mass index was 32. The hybrid approach was 8.5 minutes shorter compared to the conventional approach (p <0.001). No complications higher than Clavien-Dindo IIIb (n = 2) were observed (in both groups). Complete success (the resolution of pain and/or hydronephrosis) was observed in 92.5% in the hybrid group and in 95.7% in the conventional treatment group. Conclusions Hybrid pyeloplasty may be considered safe and effective. It has the advantage of making the surgery less challenging and time-consuming while offering improved precision. The advantages of the technique are particularly apparent during training. This technique can be recommended in the learning process of the surgeon.

Original languageEnglish (US)
Pages (from-to)413-417
Number of pages5
JournalCentral European Journal of Urology
Volume72
Issue number4
DOIs
StatePublished - Jan 1 2019

Keywords

  • Extracorporeal ureter handling
  • Hydronephrosis
  • Laparoscopic pyeloplasty
  • Ureteropelvic junction obstruction

ASJC Scopus subject areas

  • Urology

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    Enikeev, M., Gahan, J., Yossepowitch, O., Rapoport, L., Grigoryan, V., Abdusalamov, A., Lobanov, M., Chuvalov, L., Taratkin, M., Ali, S., Gaas, M., Enikeev, D., & Glybochko, P. (2019). Extracorporeal ureter handling during laparoscopic pyeloplasty: Tips and tricks for beginners. Central European Journal of Urology, 72(4), 413-417. https://doi.org/10.5173/ceju.2019.0022