Lumboscopic-assisted pyeloplasty: A single-port, retroperitoneoscopic approach for children with pelvi-ureteric junction obstruction
Introduction: Pelvi-ureteric junction obstruction (PUJO) is one of the most common conditions presenting to a pediatric urologist. As laparoscopic or robotic-assisted pyeloplasty, either transperitoneal or retroperitoneal, involves intracorporeal suturing skills and has a long learning curve, they h...
| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
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Wolters Kluwer Medknow Publications
2020-01-01
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| Series: | Journal of Indian Association of Pediatric Surgeons |
| Subjects: | |
| Online Access: | http://www.jiaps.com/article.asp?issn=0971-9261;year=2020;volume=25;issue=3;spage=163;epage=168;aulast=Bajpai |
| _version_ | 1818229750820241408 |
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| author | Minu Bajpai Kashish Khanna Vikram Khanna Prabudh Goel Dalim Kumar Baidya |
| author_facet | Minu Bajpai Kashish Khanna Vikram Khanna Prabudh Goel Dalim Kumar Baidya |
| author_sort | Minu Bajpai |
| collection | DOAJ |
| description | Introduction: Pelvi-ureteric junction obstruction (PUJO) is one of the most common conditions presenting to a pediatric urologist. As laparoscopic or robotic-assisted pyeloplasty, either transperitoneal or retroperitoneal, involves intracorporeal suturing skills and has a long learning curve, they have not gained popularity among beginners in laparoscopy.
Objective: We conducted a study to assess the results of a single-port, retroperitoneoscopic approach to renal access, i.e. lumboscopic-assisted pyeloplasty (LAP), by single surgeon at our institute.
Materials and Methods: A retrospective review of all children who underwent LAP from July 2013 to March 2018 was conducted. Patients who presented with PUJO and required surgical treatment were included. A single-port lumboscopy using coaxial telescope was performed in prone position in all patients. The renal pelvis was dissected and retrieved through the port site followed by extracorporeal hand-sewn pyeloplasty over a double–J stent or a nephrostent. The operative time, postoperative pain, surgical complications, duration of hospital stay, follow-up, and cosmesis at 6 months postsurgery were evaluated.
Results: A total of 96 children were included (72 males and 24 females), with the age at operation ranging from 3 months to 10 years (mean = 4.9 years). All patients had an uneventful postoperative recovery. Two patients had a superficial wound infection, and one patient was converted to open approach due to excessive bleeding. The average operating time was 80 ± 22.5 min, the median duration of hospital stay was 3 days, and the average scar length at 3 months was 15.6 ± 0.4 mm. Follow-up renogram (diethylenetriamine pentaacetic acid) showed satisfactory postpyeloplasty drainage pattern in 93 children while three showed obstructive drainage curves.
Conclusion: LAP can be performed safely with minimal retroperitoneal dissection, excellent cosmetic results, and minimal postoperative pain in children with PUJO. It has a shorter learning curve as compared to laparoscopic pyeloplasty as it involves time tested extracorporeal hand-sewn anastomosis. |
| first_indexed | 2024-12-12T10:23:34Z |
| format | Article |
| id | doaj.art-f43f111223fe4c778859b9f9a88b083c |
| institution | Directory Open Access Journal |
| issn | 0971-9261 1998-3891 |
| language | English |
| last_indexed | 2024-12-12T10:23:34Z |
| publishDate | 2020-01-01 |
| publisher | Wolters Kluwer Medknow Publications |
| record_format | Article |
| series | Journal of Indian Association of Pediatric Surgeons |
| spelling | doaj.art-f43f111223fe4c778859b9f9a88b083c2022-12-22T00:27:30ZengWolters Kluwer Medknow PublicationsJournal of Indian Association of Pediatric Surgeons0971-92611998-38912020-01-0125316316810.4103/jiaps.JIAPS_5_19Lumboscopic-assisted pyeloplasty: A single-port, retroperitoneoscopic approach for children with pelvi-ureteric junction obstructionMinu BajpaiKashish KhannaVikram KhannaPrabudh GoelDalim Kumar BaidyaIntroduction: Pelvi-ureteric junction obstruction (PUJO) is one of the most common conditions presenting to a pediatric urologist. As laparoscopic or robotic-assisted pyeloplasty, either transperitoneal or retroperitoneal, involves intracorporeal suturing skills and has a long learning curve, they have not gained popularity among beginners in laparoscopy. Objective: We conducted a study to assess the results of a single-port, retroperitoneoscopic approach to renal access, i.e. lumboscopic-assisted pyeloplasty (LAP), by single surgeon at our institute. Materials and Methods: A retrospective review of all children who underwent LAP from July 2013 to March 2018 was conducted. Patients who presented with PUJO and required surgical treatment were included. A single-port lumboscopy using coaxial telescope was performed in prone position in all patients. The renal pelvis was dissected and retrieved through the port site followed by extracorporeal hand-sewn pyeloplasty over a double–J stent or a nephrostent. The operative time, postoperative pain, surgical complications, duration of hospital stay, follow-up, and cosmesis at 6 months postsurgery were evaluated. Results: A total of 96 children were included (72 males and 24 females), with the age at operation ranging from 3 months to 10 years (mean = 4.9 years). All patients had an uneventful postoperative recovery. Two patients had a superficial wound infection, and one patient was converted to open approach due to excessive bleeding. The average operating time was 80 ± 22.5 min, the median duration of hospital stay was 3 days, and the average scar length at 3 months was 15.6 ± 0.4 mm. Follow-up renogram (diethylenetriamine pentaacetic acid) showed satisfactory postpyeloplasty drainage pattern in 93 children while three showed obstructive drainage curves. Conclusion: LAP can be performed safely with minimal retroperitoneal dissection, excellent cosmetic results, and minimal postoperative pain in children with PUJO. It has a shorter learning curve as compared to laparoscopic pyeloplasty as it involves time tested extracorporeal hand-sewn anastomosis.http://www.jiaps.com/article.asp?issn=0971-9261;year=2020;volume=25;issue=3;spage=163;epage=168;aulast=Bajpaihydronephrosislumboscopic assistedpelvi-ureteric junction obstructionretroperitoneoscopicsingle-port pyeloplasty |
| spellingShingle | Minu Bajpai Kashish Khanna Vikram Khanna Prabudh Goel Dalim Kumar Baidya Lumboscopic-assisted pyeloplasty: A single-port, retroperitoneoscopic approach for children with pelvi-ureteric junction obstruction Journal of Indian Association of Pediatric Surgeons hydronephrosis lumboscopic assisted pelvi-ureteric junction obstruction retroperitoneoscopic single-port pyeloplasty |
| title | Lumboscopic-assisted pyeloplasty: A single-port, retroperitoneoscopic approach for children with pelvi-ureteric junction obstruction |
| title_full | Lumboscopic-assisted pyeloplasty: A single-port, retroperitoneoscopic approach for children with pelvi-ureteric junction obstruction |
| title_fullStr | Lumboscopic-assisted pyeloplasty: A single-port, retroperitoneoscopic approach for children with pelvi-ureteric junction obstruction |
| title_full_unstemmed | Lumboscopic-assisted pyeloplasty: A single-port, retroperitoneoscopic approach for children with pelvi-ureteric junction obstruction |
| title_short | Lumboscopic-assisted pyeloplasty: A single-port, retroperitoneoscopic approach for children with pelvi-ureteric junction obstruction |
| title_sort | lumboscopic assisted pyeloplasty a single port retroperitoneoscopic approach for children with pelvi ureteric junction obstruction |
| topic | hydronephrosis lumboscopic assisted pelvi-ureteric junction obstruction retroperitoneoscopic single-port pyeloplasty |
| url | http://www.jiaps.com/article.asp?issn=0971-9261;year=2020;volume=25;issue=3;spage=163;epage=168;aulast=Bajpai |
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