Aminsharifi Alireza, Molaie Afshin, Monsef Alireza
1 Department of Urology, Shiraz University of Medical Sciences , Shiraz, Iran .
2 Laparoscopy Research Center, Shiraz University of Medical Sciences , Shiraz, Iran .
J Endourol. 2018 Mar;32(3):218-222. doi: 10.1089/end.2017.0538. Epub 2017 Dec 12.
To describe the technique of laparoscopic in situ dismembered pyeloplasty as a modified technique during which the alignment of ureter and renal pelvis remains intact during ureteropelvic junction (UPJ) anastomosis. We also assessed intraoperative and postoperative outcomes of this modification in comparison to standard laparoscopic dismembered pyeloplasty.
Patients with significant primary UPJ obstruction without any history of abdominal surgery, high ureter insertion, or renal anomalies were considered. The patients were consecutively enrolled one after another into one of two study groups: classic laparoscopic dismembered pyeloplasty (Group I) or laparoscopic in situ dismembered pyeloplasty (Group II), however, those with aberrant vessels crossing the UPJ were allocated specifically to Group I because UPJ anastomosis should be done anterior to the aberrant vessels. Demographic data, intraoperative timings, and postoperative and follow-up outcomes were compared in the two groups.
Patients in Group I (n = 23) and Group II (n = 14) had similar demographic characteristics. Mean operative time was significantly longer in Group I (103.8 ± 19.95 minutes vs 89.5 ± 18.90 minutes, p = 0.038). Total duration of UPJ repair and anastomosis was also significantly longer in Group I (92.7 ± 15.82 minutes vs 78.4 ± 14.76 minutes, p = 0.021). The method of pyeloplasty significantly affected the time required to prepare ureter and renal pelvis (p = 0.017) and the duration of UPJ anastomosis (p = 0.014). Both were shorter in Group II. Mean follow-up period was 14.4 ± 7.42 months in Group I and 14.05 ± 7.93 months in Group II (p = 0.88). Success rate was 95.6% in Group I and 100% in Group II (p = 0.42).
Laparoscopic in situ pyeloplasty is a safe and effective approach that can help simplify laparoscopic pyeloplasty, especially at teaching centers where surgeons with variable levels of experience perform laparoscopic procedures.
描述腹腔镜原位离断肾盂成形术这一改良技术，在此技术中输尿管肾盂连接部（UPJ）吻合时输尿管与肾盂的对合保持完整。我们还将这种改良技术与标准腹腔镜离断肾盂成形术相比较，评估其术中及术后结果。
纳入有明显原发性UPJ梗阻、无腹部手术史、输尿管高位插入或肾脏异常的患者。患者被依次连续纳入两个研究组之一：经典腹腔镜离断肾盂成形术组（I组）或腹腔镜原位离断肾盂成形术组（II组），然而，有异常血管横跨UPJ的患者被专门分配至I组，因为UPJ吻合应在异常血管前方进行。比较两组的人口统计学数据、术中时间、术后及随访结果。
I组（n = 23）和II组（n = 14）患者的人口统计学特征相似。I组的平均手术时间显著更长（103.8 ± 19.95分钟 vs 89.5 ± 18.90分钟，p = 0.038）。I组UPJ修复和吻合的总时长也显著更长（92.7 ± 15.82分钟 vs 78.4 ± 14.76分钟，p = 0.021）。肾盂成形术方法显著影响准备输尿管和肾盂所需时间（p = 0.017）以及UPJ吻合时长（p = 0.014）。二者在II组均更短。I组的平均随访期为14.4 ± 7.42个月，II组为14.05 ± 7.93个月（p = 0.88）。I组成功率为95.6%，II组为100%（p = 0.42）。
腹腔镜原位肾盂成形术是一种安全有效的方法，可有助于简化腹腔镜肾盂成形术，尤其是在不同经验水平的外科医生进行腹腔镜手术的教学中心。
