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Minimal incision laparoscopy assisted open pediatric pyeloplasty
Jason R Woo1, Sarah Marietti2, James Masterson3
1Department of Urology, University of California - San Diego Health System, San Diego, CA, USA.
Abstract:
Minimal incision laparoscopy-assisted open pyeloplasty (MILAP) incorporates elements of open pyeloplasty (OP) and single incision laparoscopy to improve technical ease and cosmetic outcomes. Six MILAP procedures were performed using a single transumbilical incision through which the ureteropelvic junction (UPJ) is mobilized with standard laparoscopic instrumentation. The UPJ is brought extracorporeally through a 1-cm flank incision, and a traditional Anderson-Hynes open pyeloplasty is performed. Compared with OP, perioperative outcomes were similar. Follow-up renal scans all showed improvement of obstruction. A 1-cm flank incision is the only obvious scar.
Insights
Minimal incision laparoscopy-assisted open pyeloplasty (MILAP) offers improved cosmetic outcomes with similar perioperative results compared to traditional open pyeloplasty. This technique effectively resolves ureteropelvic junction obstruction with a single, small flank scar.
Area of Science:
- Urology
- Minimally Invasive Surgery
- Pediatric Surgery
Background:
- Ureteropelvic junction (UPJ) obstruction is a common cause of pediatric renal disease.
- Traditional open pyeloplasty (OP) is effective but results in a significant scar.
- Laparoscopic techniques aim to reduce invasiveness and improve cosmesis.
Purpose of the Study:
- To evaluate the safety and efficacy of a novel Minimal Incision Laparoscopy-Assisted Open Pyeloplasty (MILAP) technique.
- To assess the technical feasibility and cosmetic benefits of MILAP.
- To compare MILAP outcomes with traditional OP.
Main Methods:
- Six MILAP procedures were performed using a single transumbilical incision for laparoscopic mobilization of the UPJ.
- The UPJ was brought extracorporeally through a 1-cm flank incision for a traditional Anderson-Hynes open pyeloplasty.
- Perioperative outcomes and postoperative renal scans were analyzed.
Main Results:
- MILAP demonstrated similar perioperative outcomes compared to OP.
- All patients showed improvement in renal obstruction on follow-up scans.
- The only significant visible scar was a 1-cm flank incision.
Conclusions:
- MILAP is a safe and effective alternative for UPJ obstruction treatment.
- The technique combines the benefits of laparoscopy for cosmesis with the familiarity of open pyeloplasty.
- MILAP offers excellent functional and cosmetic results for UPJ obstruction.