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

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.

• Authors: Soroush Rais-Bahrami, Emad R Rizkala, Jeffrey A Cadeddu, Volkan Tugcu, Ithaar H Derweesh, Aly M Abdel-Karim, Akihiro Kawauchi, Arvin K George, Riccardo Autorino, Aditya Bagrodia, Erkan Sonmezay, Salah Elsalmy, Michael A Liss, Brian M Harrow, Jihad H Kaouk, Lee Richstone, Robert J Stein
• Journal: Urology (Urology) Vol. 82 Issue 2 Pg. 366-72 (Aug 2013) ISSN: 1527-9995 [Electronic] United States
• PMID: 23810729 (Publication Type: Journal Article, Multicenter Study)
• Copyright: Copyright © 2013 Elsevier Inc. All rights reserved.

Topics

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