Extracorporeal ureter handling during laparoscopic pyeloplasty: tips and tricks for beginners.
extracorporeal ureter handling
hydronephrosis
laparoscopic pyeloplasty
ureteropelvic junction obstruction
Journal
Central European journal of urology
ISSN: 2080-4806
Titre abrégé: Cent European J Urol
Pays: Poland
ID NLM: 101587101
Informations de publication
Date de publication:
2019
2019
Historique:
received:
15
08
2019
revised:
04
11
2019
accepted:
16
11
2019
entrez:
5
2
2020
pubmed:
6
2
2020
medline:
6
2
2020
Statut:
ppublish
Résumé
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 intracorporeal-extracorporeal approach to upper tract ureteral reconstruction facilitates ureteral preparation at the stage of mastering the technique. 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. 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. 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.
Identifiants
pubmed: 32015913
doi: 10.5173/ceju.2019.0022
pii: 0022
pmc: PMC6979559
doi:
Types de publication
Journal Article
Langues
eng
Pagination
413-417Informations de copyright
Copyright by Polish Urological Association.
Déclaration de conflit d'intérêts
All authors state that they have no conflict of interest that might potentially bias their work.
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