Laparoendoscopic single-site pyeloplasty: Outcomes of an international multi-institutional study of 140 patients

Soroush Rais-Bahrami, Emad R. Rizkala, Jeffrey A Cadeddu, Volkan Tugcu, Ithaar H. Derweesh, Aly M. Abdel-Karim, Akihiro Kawauchi, Arvin K. George, Riccardo Autorino, Aditya Bagrodia, Erkan Sonmezay, Salah Elsalmy, Michael A. Liss, Brian M. Harrow, Jihad H. Kaouk, Lee Richstone, Robert J. Stein

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14 Scopus citations

Abstract

Objective: To report an international, multi-institutional series of laparoendoscopic single-site pyeloplasty (LESS-P) with analysis of functional outcomes. Materials and Methods: LESS-P cases performed between October 2007 and June 2012 at 7 institutions worldwide per individual institutional protocols, entry criteria, and techniques were included. Patient characteristics, operative indications, perioperative outcomes, and postoperative follow-up were retrospectively collected and analyzed. Results: The study included 140 adult patients (age 39.9 ± 15.7 years; body mass index 24.8 ± 4.2 kg/m2; 15% with previous abdominal surgery) who underwent unilateral LESS-P, most of whom (94.3%) had dismembered reconstructions. Mean operative time was 202.1 ± 47 minutes with an estimated blood loss of 61.2 ± 44.6 mL. Robotic laparoendoscopic single-site surgery was applied in 31 patients (22.1%). A single 2-3 mm accessory port was used in 44 patients (31.4%) and a single 5-12 mm accessory port was added in 9 patients (6.4%), whereas 10 patients (7.1%) were converted to conventional multiport laparoscopy. No patients required conversion to open surgery, nor were any intraoperative complications reported. Length of hospitalization was 2.4 ± 1.6 days. The overall 90-day postoperative complication rate was 18.6%, mostly low-grade complications (Clavien I-II). With a mean follow-up of 14.0 ± 10.8 months, 93.4% had resolution of symptoms and 94.4% had radiographic evidence demonstrating resolution of ureteropelvic junction obstruction. Assessment of drainage with diuretic nuclear renal scan provided evidence of improvement in 86.5% of patients on their first postoperative renal scan. Conclusion: This study highlights the most comprehensive experience with LESS-P reported to date. Outcome measures parallel those of large published series of conventional laparoscopic pyeloplasty. Despite these encouraging findings, longer follow-up is needed to determine the efficacy and durability of this approach for the treatment of ureteropelvic junction obstruction.

Original languageEnglish (US)
Pages (from-to)366-372
Number of pages7
JournalUrology
Volume82
Issue number2
DOIs
StatePublished - Aug 1 2013

ASJC Scopus subject areas

  • Urology

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    Rais-Bahrami, S., Rizkala, E. R., Cadeddu, J. A., Tugcu, V., Derweesh, I. H., Abdel-Karim, A. M., Kawauchi, A., George, A. K., Autorino, R., Bagrodia, A., Sonmezay, E., Elsalmy, S., Liss, M. A., Harrow, B. M., Kaouk, J. H., Richstone, L., & Stein, R. J. (2013). Laparoendoscopic single-site pyeloplasty: Outcomes of an international multi-institutional study of 140 patients. Urology, 82(2), 366-372. https://doi.org/10.1016/j.urology.2013.04.047