Laparoscopic-Assisted Extracorporeal Pyeloplasty: A Minimally Invasive Approach to Pediatric Ureteropelvic Junction Obstruction

摘要

Background: Ureteropelvic junction obstruction (UPJO) is a common congenital anomaly in pediatrics that may require surgical intervention performed by open, laparoscopic-assisted, laparoscopic, or robotic-assisted fashion. Laparoscopic pyeloplasty hasn't become popular due to instrument or skill limitations. Laparoscopic-assisted pyeloplasty could be the first step towards a minimally invasive approach to UPJO in pediatrics. Methods: The current study was conducted on 60 infants with UPJO treated with either laparoscopic-assisted extracorporeal or open pyeloplasty. In our modified approach, the ureteropelvic junction was exposed and released laparoscopically and pulled out of the abdominal cavity and pyeloplasty was performed simply over a JJ stent. The second group was treated by conventional posterior lumbotomy approach. All patients were followed up after the operation at least for six months and the results were compared between the two groups. Results: Comparison of the pelvic anteroposterior diameter before and after the operation indicated a significant reduction after the operation in both groups. Diuretic scan after JJ catheter removal did not show signs of obstruction in almost all cases among both groups. Comparison of the postoperative complications revealed no significant differences between the two groups. The complication rate was also very low and almost the same in both groups. Conclusions: Full laparoscopic pyeloplasty demands advanced surgical skills and fine instruments, which made it time-consuming and less applicable widely. Laparoscopic-assisted pyeloplasty is more applicable while it showed acceptable results in the current study. The current approach is suggested as the first step toward MIS for UPJO in pediatrics.