Hybrid laparoendoscopic single-site (LESS) pyeloplasty: Initial experience in children

Area of Science:

• Pediatric Urology
• Minimally Invasive Surgery
• Surgical Innovation

Background:

• Ureteropelvic junction obstruction is a common congenital anomaly in children.
• Minimally invasive surgical techniques are continuously evolving for improved patient outcomes.
• Laparoendoscopic single-site pyeloplasty (LESS) presents challenges in surgical steps.

Purpose of the Study:

• To compare the efficacy and outcomes of hybrid pyeloplasty with conventional open pyeloplasty and standard laparoendoscopic single-site pyeloplasty (LESS) in children.
• To evaluate the technical modifications of hybrid pyeloplasty in simplifying LESS procedures.
• To assess the safety and effectiveness of hybrid pyeloplasty for pediatric ureteropelvic junction obstruction.

Main Methods:

• Retrospective review of pediatric patients (<14 years) with ureteropelvic junction obstruction undergoing pyeloplasty from 2011-2015.
• Comparison of three surgical approaches: open pyeloplasty, laparoendoscopic single-site pyeloplasty (LESS), and hybrid pyeloplasty.
• Data collected included demographics, operative time, hospital stay, drainage, complications, and outcomes assessed by sonography and renography.

Main Results:

• 38 patients were analyzed: 17 open pyeloplasty, 10 LESS, and 11 hybrid pyeloplasty.
• Hybrid pyeloplasty demonstrated significantly shorter operative times compared to open and LESS pyeloplasty (P<0.001).
• The shortest median hospital stay was observed in the hybrid pyeloplasty group, with a mean follow-up of 26 months.

Conclusions:

• Hybrid pyeloplasty effectively combines the successful outcomes of open surgery with the advantages of minimally invasive approaches.
• This technique provides a smaller incision, adequate working space, reduced operative time, secure anastomosis, and favorable cosmetic results.
• Hybrid pyeloplasty represents a promising advancement for treating pediatric ureteropelvic junction obstruction.