Steps to reduce operative time in laparoscopic dismembered pyeloplasty for moderate to large renal pelvis

To describe the steps to reduce the operative time for laparoscopic dismembered pyeloplasty in ureteropelvic junction obstruction with moderate to large hydronephrosis.

Using a transperitoneal approach and three ports, pyelotomy was done proximal to the ureteropelvic junction, and the ureter was spatulated laterally before dismembering it. Using the three suture line technique, the first suture was taken at the distal end of the spatulated ureter outside-in to the most dependent part of the pelvis inside-out and left as such. The second suture was taken at the proximal end of the ureter outside-in to the corresponding site at the posterior wall of the pelvis and then continued distally to complete the posterior suture line. A double-J stent was placed in an antegrade way. The anterior wall was completed with the first suture, taking continuous bites. The third suture line was used to close the pelvis. The operative time was recorded from placing the patient in the lateral position to the closure of the last port.

From January 2002 to January 2004, 24 patients underwent pyeloplasty performed by a single surgeon. The mean pelvic volume was 80.4 cm3 (range 70 to 110). The mean patient age was 24.5 years (range 5 to 57). The body mass index was 22.28 kg/m2 (range 20 to 25). The mean operative time was 120.4 minutes (range 80 to 160). Minor complications were noted in 3 patients. All patients showed improvement in symptoms and drainage after a mean follow-up of 17 months (range 10 to 28).

These steps helped to reduce the operative time to close to that of open surgery, making laparoscopic pyeloplasty a more desirable alternative.