Microlaparoscopic pyeloplasty. 120 cases experience

The aim of the study was to evaluate functional results of microlaparoscopy compared with standard laparoscopy in pyeloplasty in adults. Patients and methods. The study included 120 patients who underwent microlaparoscopic pyeloplasty (MLP) - and 101 standard laparoscopic pyeloplasty (SLP). MLP was performed with two or three 2.5-3 mm trocars (Storz) and one 5 mm trocar for the Hd-laparoscope installed through the navel. In all cases Hynes- Anderson procedure was performed with antegrade insertion of stent. Two continuous 5-0 biosyn sutures were used for anastomosis. Stent was removed after 6 weeks and evaluation of renal function was performed in 3-6 months. Results. All options of laparoscopic pyeloplasty provide good postoperative results: 100% - MLP and 98% - SLP (defined as absense of pain and/or T1/2 improvement). There was no conversion. There were no statistically significant differences in complications, duration of hospital stay. After 3-4 months postoperative scars were almost invisible in the navel, and the sites from 3 mm trocars were like little moles, at the same time SLP postoperative scars were more noticeable. Conclusion. In our study MLP showed the same functional outcome and safety in comparison with the SLP. MLP with Hd-vision allows the use of thin filaments № 5-0 for anastomosis to provide greater operative precision that made it a standard method of pyeloplasty in our clinic with regard to a better cosmetic result achieved.

гидронефроз, пиелопластика, лапароскопия, микролапароскопия, минилапароскопия, минимальноинвазивная хирургия, hydronephrosis, UPJO, pyeloplasty, minimally invasive surgery, laparoscopy, microlaparoscopy, minilaparoscopy

1. Schuessler WW, Grune MT, Tecuanhuey LV, Preminger GM. Laparoscopic dis- membered pyeloplasty. J Urol 1993;150:1795-1799. doi: 8230507

2. Desai MM, Berger AK, Brandina R, Aron M, Irwin BH, Canes D, et al. Laparoendoscopic single-site surgery: initial hundred patients. Urology 2009;74:805-812. doi: 10.1590/S1677-5538.IBJU.0444

3. Hanske J., Sanchez A., Schmid M., et al. Comparison of 30-day perioperative outcomes in adults undergoing open versus minimally invasive pyeloplasty for ureteropelvic junction obstruction: analysis of 593 patients in a prospective national database. World Journal of Urology. 2015;33(12):2107-2113.

4. Boylu U., Basatac C., Turan T., Onol F. F., Gumus E. Comparison of surgical and functional outcomes of minimally invasive and open pyeloplasty. Journal of Laparoendoscopic and Advanced Surgical Techniques. 2012;22(10):968-971.

5. Baçataç C., Boylu U., ÖnolF. F., GümüçE. Comparison of surgical and functional outcomes of open, laparoscopic and robotic pyeloplasty for the treatment of ureteropelvic junction obstruction. Turk Uroloji Dergisi. 2014;40(1):24-30.

6. Porpiglia F, Autorino R, Cicione A, et al. Contemporary urologic minilaparoscopy: indications, techniques, and surgical outcomes in a multi-institutional European cohort. J Endourol 2014;28:951-7.

7. Fiori C, Morra I, Bertolo R, Mele F, Chiarissi ML, Porpiglia F. Standard vs mini-laparoscopic pyeloplasty: Perioperative outcomes and cosmetic results. BJU Int 2013;111:E121-6.

8. Pini G, Goezen AS, Schulze M, Hruza M, Klein J, Rassweiler JJ. Small-incision access retroperitoneoscopic technique (SMART) pyeloplasty in adult patients: comparison of cosmetic and postoperative pain outcomes in a matched-pair analysis with standard retroperitoneoscopy: preliminary report. World J Urol 2011; [Epub ahead of print]. DOI: 10.1007/s00345-011-0740-x

9. Pini G, Goezen AS, Schulze M, Hruza M, Klein J, Rassweiler JJ. Small-incision access retroperitoneoscopic technique (SMART) pyeloplasty in adult patients: Comparison of cosmetic and postoperative pain outcomes in a matched- pair analysis with standard retroperitoneoscopy: Preliminary report. World J Urol 2012;30: 605-11.