C William Schwab1, Pasquale Casale. 1. Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia 19104, USA.
Abstract
PURPOSE: Laparoscopic pyeloplasty is gaining acceptance for the treatment of ureteropelvic junction obstruction in the pediatric population, with success rates approaching those of traditional open pyeloplasty. We report our technique with a transperitoneal 4-port approach and positioning method, allowing bilateral laparoscopic dismembered pyeloplasty with 1 uninterrupted sterile field. MATERIALS AND METHODS: Two children were diagnosed with bilateral ureteropelvic junction obstruction. Following cystoscopic ureteral stent placement operative positioning was achieved with intravenous pressure infuser bags placed under each side of the patient and rotation of the table to a lateral decubitus position. Four-port transperitoneal access was used to perform bilateral dismembered pyeloplasty with interrupted 6-zero polyglactin sutures. RESULTS: Both patients had bilateral crossing vessels to the lower pole of the kidneys. Total operative time was 268 minutes and 284 minutes for the 8-year-old and the 14-year-old, respectively. The ureteral stents were removed separately at 6 and 8 weeks after repair with the patients under sedation. CONCLUSIONS: Bilateral laparoscopic pyeloplasty appears feasible for the pediatric patient.
PURPOSE: Laparoscopic pyeloplasty is gaining acceptance for the treatment of ureteropelvic junction obstruction in the pediatric population, with success rates approaching those of traditional open pyeloplasty. We report our technique with a transperitoneal 4-port approach and positioning method, allowing bilateral laparoscopic dismembered pyeloplasty with 1 uninterrupted sterile field. MATERIALS AND METHODS: Two children were diagnosed with bilateral ureteropelvic junction obstruction. Following cystoscopic ureteral stent placement operative positioning was achieved with intravenous pressure infuser bags placed under each side of the patient and rotation of the table to a lateral decubitus position. Four-port transperitoneal access was used to perform bilateral dismembered pyeloplasty with interrupted 6-zero polyglactin sutures. RESULTS: Both patients had bilateral crossing vessels to the lower pole of the kidneys. Total operative time was 268 minutes and 284 minutes for the 8-year-old and the 14-year-old, respectively. The ureteral stents were removed separately at 6 and 8 weeks after repair with the patients under sedation. CONCLUSIONS: Bilateral laparoscopic pyeloplasty appears feasible for the pediatric patient.