Laparoendoscopic single-site pyeloplasty: outcomes of an international multi-institutional study of 140 patients.

Academic Article

Abstract

  • OBJECTIVE: To report an international, multi-institutional series of laparoendoscopic single-site pyeloplasty (LESS-P) with analysis of functional outcomes. MATERIALS AND METHODS: LESS-P cases performed between October 2007 and June 2012 at 7 institutions worldwide per individual institutional protocols, entry criteria, and techniques were included. Patient characteristics, operative indications, perioperative outcomes, and postoperative follow-up were retrospectively collected and analyzed. RESULTS: The study included 140 adult patients (age 39.9 ± 15.7 years; body mass index 24.8 ± 4.2 kg/m(2); 15% with previous abdominal surgery) who underwent unilateral LESS-P, most of whom (94.3%) had dismembered reconstructions. Mean operative time was 202.1 ± 47 minutes with an estimated blood loss of 61.2 ± 44.6 mL. Robotic laparoendoscopic single-site surgery was applied in 31 patients (22.1%). A single 2-3 mm accessory port was used in 44 patients (31.4%) and a single 5-12 mm accessory port was added in 9 patients (6.4%), whereas 10 patients (7.1%) were converted to conventional multiport laparoscopy. No patients required conversion to open surgery, nor were any intraoperative complications reported. Length of hospitalization was 2.4 ± 1.6 days. The overall 90-day postoperative complication rate was 18.6%, mostly low-grade complications (Clavien I-II). With a mean follow-up of 14.0 ± 10.8 months, 93.4% had resolution of symptoms and 94.4% had radiographic evidence demonstrating resolution of ureteropelvic junction obstruction. Assessment of drainage with diuretic nuclear renal scan provided evidence of improvement in 86.5% of patients on their first postoperative renal scan. CONCLUSION: This study highlights the most comprehensive experience with LESS-P reported to date. Outcome measures parallel those of large published series of conventional laparoscopic pyeloplasty. Despite these encouraging findings, longer follow-up is needed to determine the efficacy and durability of this approach for the treatment of ureteropelvic junction obstruction.
  • Published In

  • Urology  Journal
  • Keywords

  • Adolescent, Adult, Aged, Aged, 80 and over, Blood Loss, Surgical, Female, Glomerular Filtration Rate, Humans, Kidney Pelvis, Laparoscopy, Male, Middle Aged, Operative Time, Retrospective Studies, Ureter, Ureteral Obstruction, Young Adult
  • Digital Object Identifier (doi)

    Author List

  • Rais-Bahrami S; Rizkala ER; Cadeddu JA; Tugcu V; Derweesh IH; Abdel-Karim AM; Kawauchi A; George AK; Autorino R; Bagrodia A
  • Start Page

  • 366
  • End Page

  • 372
  • Volume

  • 82
  • Issue

  • 2