The 3-port laparoscopic pyeloplasty

We describe our technique of a 3 port approach for transperitoneal laparoscopic pyeloplasty and its evolution.

Between August 1999 and February 2003, 56 patients underwent laparoscopic transperitoneal pyeloplasty. The operative procedure, including patient positioning, surgical technique and postoperative care, is described in detail. For analysis patients were divided into 2 groups, namely an initial 4 port approach and a later 3 port approach. The number of additional ports placed and the reasons why were determined.

In the initial 14 patients a 4 port plan was used and 1 (7.2%) required a fifth port. In the subsequent 42 patients surgery was initiated with a 3 port plan and 8 (19%) required 1 additional port, while 2 (4.8%) required 2 additional ports. Of the extra ports used 50% were necessary for liver retraction in procedures on the right side. In patients with greater than 10 renal calculi a retrieval pouch was used, necessitating an additional port. A planned 3 port approach was feasible in 32 of the 42 cases (76.2%) and even initially a 4 port approach was sufficient in 13 of 14 (92.9%).

We believe that our 3 port, transabdominal laparoscopic pyeloplasty technique is an efficient one with the least number of incisions and morbidity to the patient. It has proved to be feasible in more than 75% of our cases. Additional ports can easily be added but usually they are not required.