Related Experiment Videos
Retroperitoneoscopic dismembered pyeloplasty for pelvi-ureteric junction obstruction in infants and children
C K Yeung1, Y H Tam, J D Sihoe
1Division of Paediatric Surgery, Department of Surgery, Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong. ckyeung@cuhk.edu.hk
Insights
Retroperitoneoscopic dismembered pyeloplasty is a safe and effective minimally invasive procedure for pediatric pelvi-ureteric junction obstruction. This technique offers good early outcomes in infants and children, with rapid recovery.
Area of Science:
- Pediatric Urology
- Minimally Invasive Surgery
- Endourology
Background:
- Pelvi-ureteric junction (PUJ) obstruction is a common congenital anomaly in children.
- Traditional open pyeloplasty has been the gold standard, but minimally invasive techniques are gaining traction.
- Retroperitoneal laparoscopic approaches offer potential advantages in terms of cosmesis and recovery.
Purpose of the Study:
- To evaluate the initial experience and outcomes of retroperitoneoscopic dismembered pyeloplasty in infants and children.
- To assess the safety and efficacy of this minimally invasive technique for PUJ obstruction.
Main Methods:
- Retrospective review of 13 infants and children undergoing retroperitoneoscopic dismembered pyeloplasty for PUJ obstruction.
- Patients underwent the procedure in a semi-prone or semi-lateral position.
- A 5-mm laparoscope was used to perform the dismembered pyeloplasty with a double-pigtail ureteric stent.
Main Results:
- Successful retroperitoneoscopic dismembered pyeloplasty in 12 out of 13 patients (92.3%).
- One patient required open conversion due to difficulties in retroperitoneal space development.
- Mean operative time was 143 minutes, with rapid and uneventful recovery and satisfactory drainage on follow-up scans.
Conclusions:
- Retroperitoneoscopic dismembered pyeloplasty is an effective and safe surgical option for pediatric PUJ obstruction.
- The procedure demonstrates good early outcomes in infants and young children.
- Long-term results require further investigation.
Objective:
To report our initial experience of endoscopic dismembered pyeloplasty through a retroperitoneal approach in infants and children with pelvi-ureteric junction (PUJ) obstruction.
Patients And Methods:
Thirteen infants and children with PUJ obstruction underwent retroperitoneoscopic dismembered pyeloplasty (mean age at operation 2.7 years, range 0.25-10). Nine patients presented with complications secondary to PUJ obstruction, including urinary tract infection, pyonephrosis and increasing hydronephrosis with impairment in renal function. The other four patients had recurrent loin pain secondary to intermittent PUJ obstruction. The patient was placed in semi-prone (for left-sided) or a semilateral position (for right-sided PUJ obstruction). The retroperitoneal space was entered via a 1-cm incision over the mid-axillary line and further developed using a glove balloon. Video-retroperitoneoscopy was undertaken using a 5-mm laparoscope. Dismembered pyeloplasty was carried out with the pelvi-ureteric anastomosis fashioned using fine polydioxanone sutures over a double-pigtail ureteric stent.
Results:
The retroperitoneoscopic dismembered pyeloplasty was successful in 12 patients, while one with previous percutaneous nephrostomy drainage for pyonephrosis required open conversion because of difficulties in developing the retroperitoneal space. The mean (range) operative duration was 143 (103-235) min. All patients had a rapid and uneventful recovery. The drainage was satisfactory in all 12 patients on a follow-up scan.
Conclusions:
Retroperitoneoscopic dismembered pyeloplasty is effective and safe in infants and young children giving a good early outcome, although the long-term results await further studies.