Pediatric laparoscopic pyeloplasty in a referral center: lessons learned
Related Experiment Video
Updated: Jul 13, 2026
Transmesenteric Laparoscopic Pyeloplasty in Trendelenburg Position for Horseshoe Kidney with Hydronephrosis
Published on: July 8, 2025
Luis H Braga1, Joao Pippi-Salle, Armando J Lorenzo
1Division of Urology, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
Insights
This study details the first year of pediatric transperitoneal laparoscopic dismembered pyeloplasty (TLDP), a minimally invasive surgery for ureteropelvic junction obstruction. Key techniques were implemented, showing a learning curve with early complications that were successfully managed.
Area of Science:
- Pediatric Urology
- Minimally Invasive Surgery
- Surgical Techniques
Background:
- Ureteropelvic junction obstruction is a common cause of hydronephrosis in children.
- Traditional open pyeloplasty can be associated with significant morbidity.
- Laparoscopic approaches offer potential benefits in terms of recovery and cosmesis.
Purpose of the Study:
- To present the initial 1-year experience with pediatric transperitoneal laparoscopic dismembered pyeloplasty (TLDP).
- To describe key procedural steps implemented to standardize the technique.
- To evaluate the safety and efficacy of TLDP in pediatric patients.
Main Methods:
- A retrospective chart review of 27 children undergoing TLDP for ureteropelvic junction obstruction.
- Implementation of specific surgical techniques: Foley catheter distention, renal pelvis traction suture, modified double-armed suture, and percutaneous antegrade stent placement.
- Analysis of operative time, hospital stay, complications, and radiologic outcomes.
Main Results:
- TLDP was successfully performed in all 27 patients without open conversion.
- Mean operative time was 221 minutes; average hospital stay was 2.1 days.
- Four postoperative complications (14.8%) occurred early in the series and were managed successfully. All patients showed reduced hydronephrosis on follow-up imaging.
Conclusions:
- The first year of TLDP demonstrated the feasibility of a standardized technique with specific procedural modifications.
- A learning curve is evident, with early complications being more frequent but manageable.
- TLDP is a viable option for pediatric ureteropelvic junction obstruction, with encouraging initial outcomes.
Purpose:
We present our first-year experience with pediatric transperitoneal laparoscopic dismembered pyeloplasty (TLDP) in a large referral center.
Patients And Methods:
A chart review was conducted in 27 consecutive children (M:F 23:4) aged 4 to 17 years (mean 9.7 years) with ureteropelvic junction obstruction who underwent TLDP (21 on the left, 6 on the right) in 2005. The key steps implemented to facilitate and streamline this procedure were: (1) clamping the Foley catheter before surgery to distend the renal pelvis and facilitate the transmesenteric approach; (2) stabilizing the renal pelvis with a traction suture; (3) performing the dismembered pyeloplasty using a modified double-armed suture; and (4) placing the ureteral stent percutaneously antegrade before completing the anastomosis. Operative time, hospital stay, complications, and follow-up radiologic studies were reviewed.
Results:
The TLDP was performed with no open conversions. Crossing vessels and horseshoe kidney were present in 8 patients and 2 patients, respectively. The mean operative time was 221 minutes. Stent insertion was successful in all but one patient. Postoperative pain management was successful in all 27 patients. There were 4 postoperative complications (14.8%) consisting of prolonged leakage in two, obstruction in one, and obstruction with pyelonephritis in one. These last two complications occurred early in our experience and were treated successfully by percutaneous nephrostomy with subsequent retrograde endopyelotomy. The average hospital stay was 2.1 days (range 1-4 days). Radiologic studies 8 to 20 months after removal of the Double-J stents showed reduction of the degree of hydronephrosis in all patients.
Conclusion:
Our 1-year experience with TLDP gave us the opportunity to implement key steps to establish a standardized technique for this procedure. Although the follow-up period was short, most complications occurred early in this series, demonstrating that a learning curve is inevitable.
