Laparoscopic pyeloplasty through transperitoneal access – operative results of the first 12 cases in our practice

Abstract

Summary

Objective: To present our initial experience of the 12 cases performed with laparoscopic transperitoneal pyeloplasty in patients with obstruction of the pyeloureteral segment.

Materials and methods: For the period from 2022 to the beginning of 2024- total of 12 laparoscopic surgical interventions were performed on patients with obstruction of the pyeloureteral segment(UPJ) through transperitoneal access. The patients were 8 women and 4 men. Regarding the age indicator, the patients were in an active, "young" age, between 25 years and 49 years. For diagnosis preoperatively we used a computer tomographic examination of the abdomen and pelvis with intravenous contrast material and an excretory urographic phase.A double JJ stent was placed before the pyeloplasty. Regarding the cause of the obstruction,in 4 patients we diagnosed the presence of an aberrant vessel,in the remaining 8 we had a stenosis of the UPJ and in two we had a kidney stone in the pyelon of the kidney. 

Methods: For the treatment of UPJ we performed a laparoscopic transperitoneal pyeloplasties.The patients were operated on by one operative team with operator Dr. S. Stanimirov in two hospitals. Accordingly, 9 patients were operated on in the "St. Anna" Hospital - city ​​of Varna and 3 patients in University Hospital "Deva Maria" - city of Burgas. The team had previous laparoscopic experience in kidney and prostate surgery. Considering that to start laparoscopic pyeloplasty, it is necessary to have enough acquired laparoscopic experience. The operative team was composed of operator, assistant and operating nurse. All patients were under general intubation anesthesia. The patient was placed in a lateral position on the operating table. In all patients, the Hasson’s method was used to place the optical laparoscopic port. Two 10mm trocars were used and two 5mm. 0 degrees optics were used in the first 9 operative interventions and 30 degrees in the last 3 patients. We used the following laparoscopic instrument set: bipolar clamp - Johan type, ultrasonic scissors - Ultrasision type, monopolar scissors, dissector, grasper, needle holders. For the suture, we used an interrupted suture, with thread 3-0, slow resorption, needle ½, 19-21mm. Working pressure of CO2-12mm.Hg. 

Conclusion:Laparoscopic transperitoneal pyeloplasty is possible for our team. The initial results are encouraging and we can expect them to improve as the number of cases progresses.