Laparoscopic Pyeloplasty, Our Experience of Initial Fifty Two Cases

Objective: With the increasing popularity of minimally-invasive surgery, laparoscopic pyeloplasty has become a staple in the armamentarium of urologists. However, the surgery has a steep learning curve and longer operative time. In this study, we aimed to evaluate the results of initial 53 cases of laparoscopic dismembered pyeloplasty in our institute. Materials and Methods: A total 52 of patients with pelvi-ureteric junction (PUJ) obstruction, 30 male and 22 female, with the mean age of 23.5 years were managed by transperitoneal laparoscopic dismembered pyeloplasty. The patients were placed in full lateral position and surgery was done using a minimum of three ports, retrograde pyelography was done in all; initial access was done by using a Veress needle. The ureter was spatulated first, first suture taken and then the PUJ was dismembered to avoid rotation of the ureter. Antegrade DJ stenting was done in all patients and one drain was left in the retroperitoneum after surgery. DJ stent was removed six weeks after surgery. Results: Fifty two patients were managed by dismembered pyeloplasty. Six patients required preoperative urinary diversion. Intrarenal pelvis was seen in seven, crossing vessel in ten, high insertion of ureter in six and associated calculus in five patients. Conversion to open surgery was required in six patients. Initially, the operative time was more than three hours but after sufficient experience of 25 cases, it reduced drastically and in last 28 cases, the mean operative time was 123 minutes, with shortest time reported 97 minutes. Reintervention was required in eight patients and overall success rate was 87%. Conclusion: Laparoscopic pyeloplasty is a safe, minimally-invasive and viable alternative to open pyeloplasty for the management of PUJ obstruction.

Laparoskopik Piyeloplasti, İlk Elli İki Olgu Deneyimimiz

Amaç: Minimal invaziv cerrahinin artan popularitesiyle birlikte, Laparoskopik Piyeloplasti ürologların temel aracı haline gelmiştir. Buna karşın cerrahi, dik bir öğrenme eğrisine ve daha uzun operasyon sürelerine sahiptir. Bu çalışmada, kliniğimizde laparoskopik parçalanmış piyeloplasti gerçekleştirilen ilk 52 olguya ait sonuçların değerlendirilmesi amaçlanmıştır. Gereç ve Yöntem: Pelvi-üreterik bileşke (PÜE) darlığına sahip, 30 erkek ve 22 kadın olmak üzere yaş ortalaması 23,5 olan toplam 52 hastaya transperitoneal laparoskopik parçalanmış pyeloplasti uygulandı. Hastalar tam lateral pozisyona yerleştirildi ve en az üç port kullanılarak ameliyat yapıldı, hepsinde retrograd piyelografi yapıldı; ilk erişimde Veress iğnesi kullanıldı. Üreter ilk olarak spatüle edildi; önce sütür alındı ve daha sonra üreterin dönüşünü önlemek için PUJ parçalandı. Antegrad DJ stentleme bütün hastalara uygulandı ve operasyon sonrası retroperitonda bir diren bırakıldı. Operasyondan 6 hafta sonra DJ stent çıkarıldı. Bulgular: Elli iki hasta parçalanmış piyeloplasti ile tedavi edildi. Altı hastaya ameliyat öncesi üriner diversiyon gerekti. Yedi hastada Intrarenal pelvis, 10 hastada damar geçişi, 6 hastada yüksek yerleşimli üreter ve 5 hastada ilişkili kalkül görülmüştür. Altı hastada açık cerrahiye dönülmesi gerekmiştir. Başlangıçta operasyon süresi 3 saatten daha uzunken, 25 olguda oluşan yeterli deneyim sonrası büyük ölçüde azalmıştır. Son 28 olgunun ortalama operasyon süresi 123 dakika olup bunlar içinde en kısa süre ise 97 dakikadır. Sekiz hastada tekrar müdahale gerekirken, genel başarı oranı %87’dir. Sonuç: Laparoskopik piyeloplasti; güvenilir, minimal invaziv ve PÜE darlık yönetiminde açık piyeloplasti yerine uygulanabilir alternatif bir yöntemdir.

Kaynakça

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