64
views
0
recommends
+1 Recommend
0 collections
    0
    shares
      • Record: found
      • Abstract: found
      • Article: found
      Is Open Access

      Laparoendoscopic Single-Site (LESS) Pyeloplasty for Horseshoe Ureteropelvic Junction Obstruction

      case-report

      Read this article at

      Bookmark
          There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

          Abstract

          This report suggests that laparoscopic single-site pyeloplasty of uteropelvic junction obstruction associated with horseshoe kidney is feasible, safe, and effective in select patients.

          Abstract

          Background and Objective:

          Pyeloplasty in horseshoe kidneys can be challenging due to aberrant vasculature, renal malrotation, and ectopic location. Fewer than 20 cases of minimally invasive (MIS) pyeloplasty in horseshoe kidneys have been reported in the literature to date. We herein report the first 2 cases of laparoendoscopic single-site (LESS) pyeloplasty for UPJ obstruction in horseshoe kidneys.

          Methods:

          Two patients with symptomatic ureteropelvic junction obstruction in horseshoe kidneys were treated with an Anderson-Hynes LESS pyeloplasty. This was performed using three 5-mm trocars through a single umbilical incision, plus an accessory 3-mm port at the anterior axillary line to facilitate suturing and subsequent drain placement.

          Results:

          Both patients had BMI <23. The operative times were 204 minutes and 171 minutes. Blood loss was negligible, and no intraoperative complications occurred. To date, 9-month renography for patient 1 demonstrates stable renal function and unobstructed drainage. After stent removal, patient 2 was asymptomatic.

          Conclusion:

          In experienced hands, LESS reconstructive techniques are applicable to complex renal anomalies. LESS pyeloplasty for UPJ obstruction associated with horseshoe kidneys is feasible, safe, and effective in select patients.

          Related collections

          Most cited references15

          • Record: found
          • Abstract: found
          • Article: not found

          Laparoscopic dismembered pyeloplasty.

          As laparoscopic nephrectomy has become a viable ablative procedure for kidney removal, additional areas of reconstructive laparoscopic urological procedures are being investigated. We describe our early experience with laparoscopic pyeloplasty for the management of ureteropelvic junction obstruction. Technical highlights include initial placement of an internal ureteral stent, lateral insufflation, placement of 5, 10 mm. trocars, pyelotomy (or reduction pyeloplasty performed with articulating laparoscopic scissors, reapproximation of the ureteropelvic junction with a running 4-zero polyglactin suture, placement of a 7 mm. suction drain in the retroperitoneal space and reapproximation of the colon to the body wall with a hernia stapler. We have performed laparoscopic dismembered pyeloplasty in 5 patients with symptomatic ureteropelvic junction obstruction. Operating time ranged from 3 to 7 hours, with the majority of time devoted to laparoscopic suturing (1 to 3 hours). Hospital stay averaged 3 days and all patients returned to normal activity within 1 week. Followup averaged 12 months (range 9 to 17 months) with complete resolution of symptoms in all patients. We believe that this innovative reconstructive laparoscopic procedure can be used for treatment of complicated ureteropelvic junction obstruction as in patients with a large, redundant renal pelvis or crossing lower pole vessels.
            Bookmark
            • Record: found
            • Abstract: found
            • Article: not found

            Single-port urological surgery: single-center experience with the first 100 cases.

            To present perioperative outcomes in an observational cohort of patients who underwent LaparoEndoscopic Single Site (LESS) surgery at a single academic center. A prospective study was performed to evaluate patient outcomes after LESS urologic surgery. Demographic data including age, body mass index, operative time, estimated blood loss, operative indications, complications, and postoperative Visual Analog Pain Scale scores were accrued. Patients were followed postoperatively for evidence of adverse events. Between September 2007 and February 2009, 100 patients underwent LESS urologic surgery. Specifically, 74 patients underwent LESS renal surgery (cryoablation, 8; partial nephrectomy, 15; metastectomy, 1; renal biopsy, 1; simple nephrectomy, 7; radical nephrectomy, 6; cyst decortication, 2; nephroureterectomy, 7; donor nephrectomy, 19; and dismembered pyeloplasty, 8) and 26 patients underwent LESS pelvic surgery (varicocelectomy, 3; radical prostatectomy, 6; radical cystectomy, 3; sacral colpopexy, 13; and ureteral reimplant, 1). Mean patient age was 54 years. Mean body mass index was 26.2 kg/m(2). Mean operative time was 199 minutes. Mean estimated blood loss was 136 mL. No intraoperative complications occurred. Six patients required conversion to standard laparoscopy. Mean length of hospitalization was 3 days. Mean Visual Analog Pain Scale score at discharge was 1.5/10. At a mean follow-up of 11 months, 9 Clavien Grade II (transfusion, 7; urinary tract infection, 1; deep vein thrombosis, 1) and 2 Clavien Grade IIIb (recto-urethral fistula, 1; angioembolization, 1) surgical complications occurred. In our experience, LESS urologic surgery is feasible, offers improved cosmesis, and may offer decreased pain. Complications are consistent with the published data. Whether LESS urologic surgery is superior in comparison with standard laparoscopy is currently speculative.
              Bookmark
              • Record: found
              • Abstract: found
              • Article: not found

              Laparoendoscopic single-site surgery in urology: worldwide multi-institutional analysis of 1076 cases.

              Laparoendoscopic single-site surgery (LESS) has gained popularity in urology over the last few years. To report a large multi-institutional worldwide series of LESS in urology. Consecutive cases of LESS done between August 2007 and November 2010 at 18 participating institutions were included in this retrospective analysis. Each group performed a variety of LESS procedures according to its own protocols, entry criteria, and techniques. Demographic data, main perioperative outcome parameters, and information related to the surgical technique were gathered and analyzed. Conversions to reduced-port laparoscopy, conventional laparoscopy, or open surgery were evaluated, as were intraoperative and postoperative complications. Overall, 1076 patients were included in the analysis. The most common procedures were extirpative or ablative operations in the upper urinary tract. The da Vinci robot was used to operate on 143 patients (13%). A single-port technique was most commonly used and the umbilicus represented the most common access site. Overall, operative time was 160±93 min and estimated blood loss was 148±234 ml. Skin incision length at closure was 3.5±1.5 cm. Mean hospital stay was 3.6±2.7 d with a visual analog pain score at discharge of 1.5±1.4. An additional port was used in 23% of cases. The overall conversion rate was 20.8%; 15.8% of patients were converted to reduced-port laparoscopy, 4% to conventional laparoscopy/robotic surgery, and 1% to open surgery. The intraoperative complication rate was 3.3%. Postoperative complications, mostly low grade, were encountered in 9.5% of cases. This study provides a global view of the evolution of LESS in the field of minimally invasive urologic surgery. A broad range of procedures have been effectively performed, primarily in the academic setting, within diverse health care systems around the world. Since LESS is performed by experienced laparoscopic surgeons, the risk of complications remains low when stringent patient-selection criteria are applied. Copyright © 2011 European Association of Urology. Published by Elsevier B.V. All rights reserved.
                Bookmark

                Author and article information

                Contributors
                Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
                Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
                Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
                Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
                Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
                Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
                Journal
                JSLS
                JSLS
                jsls
                jsls
                JSLS
                JSLS : Journal of the Society of Laparoendoscopic Surgeons
                Society of Laparoendoscopic Surgeons (Miami, FL )
                1086-8089
                1938-3797
                Jan-Mar 2012
                : 16
                : 1
                : 151-154
                Affiliations
                Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
                Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
                Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
                Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
                Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
                Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
                Author notes
                Address correspondence to: Jeffrey A. Cadeddu, MD, Professor of Urology and Radiology, Department of Urology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., J8.106, Dallas, TX 75390, USA. Telephone: (214) 648-6856, Fax: (214) 648-8786, E-mail: Jeffrey.Cadeddu@ 123456UTSouthwestern.edu
                Article
                11-08-131
                10.4293/108680812X13291597716500
                3407437
                22906345
                523aabe8-c139-4563-b7b8-b24e62ce6387
                © 2012 by JSLS, Journal of the Society of Laparoendoscopic Surgeons.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial No Derivatives License ( http://creativecommons.org/licenses/by-nc-nd/3.0/), which permits for noncommercial use, distribution, and reproduction in any medium, provided the original work is properly cited and is not altered in any way.

                History
                Categories
                Case Reports

                Surgery
                horseshoe kidney,less,pyeloplasty,ureteropelvic junction obstruction
                Surgery
                horseshoe kidney, less, pyeloplasty, ureteropelvic junction obstruction

                Comments

                Comment on this article