Frontiers in Surgery (Apr 2018)
Transperitoneal Mini-Laparoscopic Pyeloplasty in Flank Position: A Safe Method for Infants and Young Adults
Abstract
Introduction and Objectives Open dismembered pyeloplasty has been the gold standard treatment for ureteropelvic junction obstruction in children. Laparoscopic pyeloplasty (LP) is becoming a standard procedure, but its acceptance is slow. We report our method for minilaparoscopy (MLP) in children using a tansperitoneal approach with the patient in the lateral flank decubitus which we found technically advantageous. Materials and MethodsRetrospective review of the records of 52 children and adolescents up to 18 years of age who underwent transperitoneal MLP at our institution during March 2012–October 2017 A 5 mm trocar is placed for the camera at the site of the umblicus by open technique, two 3 mm trocars placed in the upper and lower quadrants of the abdomen. No additional ports were necessary. 20cm long, 3-mm-diameter instruments are used. Few cases needed percutaneous fixation of the pelvis. The anastomosis is performed with 5–0 or 6–0 Polyglecaprone 25 (Monocryl®) with 13 mm half circle needle (TF plus) suture cut to 12–14 cm length and introduced through the 5-mm port. Needles are removed through the 3-mm port under direct vision. Results Fifty-two children (53 renal units) with a mean age of 82 months (range 3.5–204), a mean weight of 24,35 kg (range 7–57), and a mean follow-up of 20,44 months (6–60). Nine children were younger than 12 months, and 14 were ≤10kg. Six patients were >50kg. The mean of preoperative grade of dilatation was III (SFU scale) and postoperatively improved to SFU 0,60 (0–2). In 50 (94,3%) of the cases, there was complete resolution of hydronephrosis. There was no conversions to open surgery. Three patients suffered complications Clavien-Dindo Classification IIIb, 2 omental prolapses through a port site in two children which required general anaesthesia and one percutaneous drainage due to a leakage. No reinterventions related to stent complications or obstruction were found. Mean hospital stay was 4,69 (3–14) days. Conclusions The method of mini LP described here has proven efficient and safe. Weight appeared not to be limitation for both groups ≤10 and >50 kg.
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