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Keywords:

  • mini-laparoscopy;
  • laparoscopy;
  • pyeloplasty;
  • pelvi-ureteric junction obstruction;
  • LESS

Study Type – Therapy (case series)

Level of Evidence 4

What's known on the subject? and What does the study add?

New techniques and instrumentation in laparoscopy including the use of ‘single-port’ devices and natural orifice transluminal endoscopic surgery have been proposed to reduce the invasiveness of these procedures. The introduction of small laparoscopic instruments (<3 mm) continues to further the field. To date, mini-laparoscopic instruments have been used in many urological procedures, e.g. pyeloplasty in the paediatric population. However, data of pure mini-laparoscopic pyeloplasty (mLP) for the treatment of pelvi-ureteric junction obstruction in the adult population are lacking.

In a selected adult population mLP is feasible and safe. Perioperative and 1-year functional results are comparable with those of standard LP, while cosmetic results of mLP are more appreciated by the patients.

OBJECTIVE

  • • 
    To evaluate perioperative and cosmetic results after pure mini-laparoscopic pyeloplasty (mLP) compared with standard LP (sLP) in an adult population.

PATIENTS AND METHODS

  • • 
    From April 2009 to June 2010, 12 patients underwent mLP for pelvi-ureteric junction (PUJ) obstruction (PUJO). For comparison, 24 patients that had previously undergone sLP were pooled from our institutional database.
  • • 
    All patients were assessed preoperatively with physical examination, abdominal ultrasonography, intravenous urography or computed tomography and renal scintigraphy (RS). In all cases, an Anderson-Hynes transperitoneal approach was used.
  • • 
    After surgery, cosmetic results were assessed using a Patient Scar Assessment Questionnaire (PSAQ), and RS measured reconstructive success at 1-year after LP.
  • • 
    Demographic and perioperative variables were recorded. Groups were compared using chi-squared and Wilcoxon-Mann-Whitney tests (P < 0.05 was considered significant).

RESULTS

  • • 
    Baseline characteristics were similar between the groups. There were no differences in operative duration or blood loss. One mLP required conversion to sLP due to minor bleeding.
  • • 
    Analgesic consumption and the pain visual analogue scale scores were not significantly different between the sLP and mLP cohorts.
  • • 
    The average postoperative hospital stay for the mLP group was significantly shorter than that for the sLP group (P= 0.024).
  • • 
    Complication and success rates between the groups were not significantly different.
  • • 
    PSAQ scores showed that mLP patients were significantly more satisfied with their cosmetic result.

CONCLUSIONS

  • • 
    mLP appears to be safe, feasible and effective in the treatment of PUJOs.
  • • 
    Cosmetically, mLP is better than sLP.