Using conventional 3- and 5-mm straight instruments in laparoendoscopic single-site pyeloplasty in children

Laparoendoscopic single-site surgery (LESS) remains limited to a few relatively simple procedures in the field of pediatric surgery. We performed LESS pyeloplasty in children using conventional straight instruments and ports, and reviewed the perioperative data to evaluate the feasibility of this technique in pediatric patients.

Twenty-two consecutive patients with unilateral pelvic ureteral junction obstruction underwent LESS pyeloplasty. Their ages ranged from 2 to 134 months (mean: 56.9 months). Two 3-mm and one 5-mm conventional ports were placed in the single incision inside the umbilicus. Conventional 3-mm laparoscopic instruments and a 30-degree 5-mm camera were used for Anderson-Hynes pyeloplasty. A F4.7 or F3 pigtail stent was introduced through one of the instrument ports. A drainage was placed next to the anastomosis, which exited via the umbilical ring incision. The stent was removed 6 weeks postoperatively.

All cases were successfully completed with no need for extra-umbilical incisions. The mean operative time was 198 minutes (range: 150-270 minutes). All patients could tolerate oral food intake on postoperative day 1. One case (4.5%) developed symptoms of anastomosis obstruction and required open renal stoma. No other significant complications occurred.

LESS pyeloplasty is technically feasible in children. However, further experience and longer follow-up are necessary to appropriately evaluate the benefits and limitations of this technique.