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

Research output: Contribution to journalArticle

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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 2013

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Conversion to Open Surgery
Kidney
Intraoperative Complications
Robotics
Operative Time
Diuretics
Laparoscopy
Drainage
Hospitalization
Body Mass Index
Outcome Assessment (Health Care)
Therapeutics

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., ... 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

Laparoendoscopic single-site pyeloplasty : Outcomes of an international multi-institutional study of 140 patients. / Rais-Bahrami, Soroush; Rizkala, Emad R.; Cadeddu, Jeffrey A; Tugcu, Volkan; Derweesh, Ithaar H.; Abdel-Karim, Aly M.; Kawauchi, Akihiro; George, Arvin K.; Autorino, Riccardo; Bagrodia, Aditya; Sonmezay, Erkan; Elsalmy, Salah; Liss, Michael A.; Harrow, Brian M.; Kaouk, Jihad H.; Richstone, Lee; Stein, Robert J.

In: Urology, Vol. 82, No. 2, 08.2013, p. 366-372.

Research output: Contribution to journalArticle

Rais-Bahrami, S, Rizkala, ER, Cadeddu, JA, Tugcu, V, Derweesh, IH, Abdel-Karim, AM, Kawauchi, A, George, AK, Autorino, R, Bagrodia, A, Sonmezay, E, Elsalmy, S, Liss, MA, Harrow, BM, Kaouk, JH, Richstone, L & Stein, RJ 2013, 'Laparoendoscopic single-site pyeloplasty: Outcomes of an international multi-institutional study of 140 patients', Urology, vol. 82, no. 2, pp. 366-372. https://doi.org/10.1016/j.urology.2013.04.047
Rais-Bahrami, Soroush ; Rizkala, Emad R. ; Cadeddu, Jeffrey A ; Tugcu, Volkan ; Derweesh, Ithaar H. ; Abdel-Karim, Aly M. ; Kawauchi, Akihiro ; George, Arvin K. ; Autorino, Riccardo ; Bagrodia, Aditya ; Sonmezay, Erkan ; Elsalmy, Salah ; Liss, Michael A. ; Harrow, Brian M. ; Kaouk, Jihad H. ; Richstone, Lee ; Stein, Robert J. / Laparoendoscopic single-site pyeloplasty : Outcomes of an international multi-institutional study of 140 patients. In: Urology. 2013 ; Vol. 82, No. 2. pp. 366-372.
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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.",
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AU - Rais-Bahrami, Soroush

AU - Rizkala, Emad R.

AU - Cadeddu, Jeffrey A

AU - Tugcu, Volkan

AU - Derweesh, Ithaar H.

AU - Abdel-Karim, Aly M.

AU - Kawauchi, Akihiro

AU - George, Arvin K.

AU - Autorino, Riccardo

AU - Bagrodia, Aditya

AU - Sonmezay, Erkan

AU - Elsalmy, Salah

AU - Liss, Michael A.

AU - Harrow, Brian M.

AU - Kaouk, Jihad H.

AU - Richstone, Lee

AU - Stein, Robert J.

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N2 - 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.

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