TY - JOUR
T1 - Extracorporeal ureter handling during laparoscopic pyeloplasty
T2 - Tips and tricks for beginners
AU - Enikeev, Mikhail
AU - Gahan, Jeffrey
AU - Yossepowitch, Ofer
AU - Rapoport, Leonid
AU - Grigoryan, Vagarshak
AU - Abdusalamov, Abdusalam
AU - Lobanov, Mikhail
AU - Chuvalov, Leonid
AU - Taratkin, Mark
AU - Ali, Stanislav
AU - Gaas, Margarita
AU - Enikeev, Dmitry
AU - Glybochko, Petr
N1 - Publisher Copyright:
© 2019, Polish Urological Association. All rights reserved.
PY - 2019
Y1 - 2019
N2 - 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.
AB - 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.
KW - Extracorporeal ureter handling
KW - Hydronephrosis
KW - Laparoscopic pyeloplasty
KW - Ureteropelvic junction obstruction
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U2 - 10.5173/ceju.2019.0022
DO - 10.5173/ceju.2019.0022
M3 - Article
C2 - 32015913
AN - SCOPUS:85077532424
SN - 2080-4806
VL - 72
SP - 413
EP - 417
JO - Central European Journal of Urology
JF - Central European Journal of Urology
IS - 4
ER -