Radfar Mohammad Hadi, Afyouni Amir, Shakiba Behnam, Hamedanchi Sepehr, Zare Ali
1 Urology and Nephrology Research Center, Shahid Labbafinejad Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
2 Department of Urology, Imam Khomeini Hospital, Urmia University of Medical Sciences, Urmia, Iran.
J Laparoendosc Adv Surg Tech A. 2019 Apr;29(4):519-522. doi: 10.1089/lap.2018.0635. Epub 2019 Feb 6.
The most difficult, time-consuming, and critical steps of laparoscopic pyeloplasty (LPP) are ureteral spatulation, apical ureteral stitch placement, and ureteropelvic anastomosis. To simplify these critical steps, avoid the risk of ureteral shortening, and also minimize ureteral manipulation, we present a modified dismembered technique for suturing with the outcome of patients who underwent LPP using this technique.
This study included 23 patients who were candidates for transperitoneal dismembered Anderson-Hynes LPP. The ureter was partially cut just below the ureteropelvic junction. The ureter was spatulated at its lateral aspect to cross the obstruction site and reach the normal ureter. The renal pelvis was obliquely cut equal to the size of ureteral spatulation. The ureter and pelvis were still connected partially. At this point, the first stitch was placed between the lower point of the spatulated ureter and the lowest corner of the renal pelvis. Anastomosis was performed by running sutures.
No cases of internal organ injury and no cases of open surgery conversion were encountered. The radiologic success rate was 96%. After operation, in 1 patient, obstruction still existed and the patient underwent nephrectomy due to a nonfunctional obstructive kidney.
This modification preserves total ureteral length and facilitates spatulation and suturing in transperitoneal laparoscopic dismembered pyeloplasty. The results showed that it is a useful method, especially for less-experienced surgeons.
腹腔镜肾盂成形术（LPP）最困难、最耗时且最关键的步骤是输尿管裁剪、输尿管顶端缝线置入以及肾盂输尿管吻合。为简化这些关键步骤，避免输尿管缩短风险，并尽量减少输尿管操作，我们介绍一种改良的离断技术缝合方法，并报告采用该技术接受LPP治疗患者的结果。
本研究纳入23例适合经腹离断式安德森-海因斯LPP的患者。在肾盂输尿管交界处下方将输尿管部分切断。在输尿管外侧进行裁剪以跨越梗阻部位并延伸至正常输尿管。肾盂斜行裁剪，其大小与输尿管裁剪部分相等。输尿管与肾盂仍部分相连。此时，在裁剪后的输尿管下端点与肾盂最低角之间缝合第一针。采用连续缝合进行吻合。
未发生内脏损伤病例，也未出现转为开放手术的情况。影像学成功率为96%。术后，1例患者仍存在梗阻，因梗阻性肾无功能而接受了肾切除术。
这种改良方法保留了输尿管全长，便于经腹腹腔镜离断式肾盂成形术中的裁剪和缝合。结果表明，这是一种有用的方法，尤其适用于经验较少的外科医生。
