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Complications of laparoscopic pyeloplasty

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Abstract

Objectives

With the development of new video-endoscopic techniques like endopyelotomy, laparoscopy and retroperitoneoscopy the treatment of UPJO has become less invasive. The complications and learning curve of laparoscopic pyeloplasty are presented together with recommendations for adequate management.

Materials and methods

Based on the personal experience with 189 cases of retroperitoneoscopic pyeloplasty, a literature review (PubMed) was performed focussing on complication and success rates of the procedure. Intraoperative incidents were analysed using the Satava-classification, postoperative complications according to the Clavien-classification. The meta-analysis focussed on the experience of the 3 largest and 2 smaller series representing a cohort of 601 patients.

Results

Intraoperative incidents ranged from 2.0 to 2.3% in large series, mostly without consequences for the patient including ligation of lower pole artery, loss of needle, hyperkapnia, cutting of DJ-stent, colonic injury, and port site bleeding. The conversion rate was mainly due to inability to access UPJ or to accomplish the anastomosis ranging between 0.5 and 5.5%. Postoperative complications occured between 12.9 and 15.8% in large series. A total of 5.4–10% represented Grade III-complications, such as urine leakage, haematoma, colonic lesion, and stone formation. Recurrent UPJ-stenosis requiring reintervention was seen in 3.5–4.8%. In all three large series, complications were part of the learning curve.

Conclusion

Laparoscopic pyeloplasty has been proven safe and effective with comparable results to open surgery. The experience of pioneering centres with incidence and management of complications will be used by next generations of laparoscopic urologic surgeons to shorten their learning curve.

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References

  1. Whitaker RH (1978) Clinical assessment of pelvic and ureteral function. Urology 12:146–150

    Article  PubMed  CAS  Google Scholar 

  2. Nguyen DH, Aliabadi H, Ercole CJ, Gonzalez R (1989) Nonintubated Anderson-Hynes repair of ureteropelvic junction obstruction in 60 patients. J Urol 142:704–706

    PubMed  CAS  Google Scholar 

  3. O’Reilly PH, Brooman PJ, Mak S, Jones M, Pickup C, Atkinson C, Pollard AJ (2001) The long-term results of Anderson-Hynes pyeloplasty. BJU Int 87:287–289

    Article  PubMed  CAS  Google Scholar 

  4. Ramsey JWA, Miller RA, Kellet MJ, Blackford HN, Wickham JEA, Whitfield HM (1984) Percutaneous pyelolysis: indications, complications and results. Br J Urol 56:586–590

    Google Scholar 

  5. Badlani G, Eshghi M, Smith AD (1986) Percutaneous surgery for ureteropelvic junction obstruction (endopyelotomy): technique and early results. J Urol 135:26–28

    PubMed  CAS  Google Scholar 

  6. Inglis JA, Tolley DA (1986) Ureteroscopic pyelolysis for pelviureteric junction obstruction. Br J Urol 58:250–252

    PubMed  CAS  Google Scholar 

  7. Schuessler WW, Grune MT, Tecuanhuey LV, Preminger GM (1993) Laparoscopic dismembered pyeloplasty. J Urol 150:1795–1797

    PubMed  CAS  Google Scholar 

  8. Kavoussi LR, Peters CA (1993) Laparoscopic pyeloplasty. J Urol 150:1891–1894

    PubMed  CAS  Google Scholar 

  9. Van Cangh PJ, Wilmart JF, Opsomer RJ, Abi-Aad A, Wese FX, Lorge F (1994) Long-term results and late recurrence after endopyleotomy: a critical analysis of prognostic factors. J Urol 150:1107–1110

    Google Scholar 

  10. Recker F, Subotic B, Goepel M, Tscholl R (1995) Laparoscopic dismembered pyeloplasty: preliminary report. J Urol 153:1601–1604

    Article  PubMed  CAS  Google Scholar 

  11. Keeley FX, Bagley DH, Kulp-Hugues D, Gomella LG (1996) Laparoscopic division of crossing vessels at the ureteropelvic junction. J Endourol 10:163–165

    PubMed  Google Scholar 

  12. Janetschek G, Peschel R, Altarac S, Bartsch G (1996) Laparoscopic and retroperitoneoscopic repair of ureteropelvic junction obstruction. Urology 47:311–316

    Article  PubMed  CAS  Google Scholar 

  13. Renner C, Frede T, Seemann O, Rassweiler J (1998) Laserendopyelotomy: minimallly invasive therapy of ureteropelvic junction stenosis. J Endourol 12:537–544

    Article  PubMed  CAS  Google Scholar 

  14. Soulie M, Salomon L, Patard JJ, Mouly P, Manunta A, Antiphon P, Lobel B, Abbou CC, Plante P (2001) Extraperitoneal laparoscopic pyeloplasty: a multicenter study of 55 procedures. J Urol 166:48–50

    Article  PubMed  CAS  Google Scholar 

  15. Türk IA, Davis JW, Winkelmann B, Deger S, Ridhter F, Fabrizio MD, Schönberger B, Jordan GH, Loening SA (2002) Laparoscopic dismembered pyeloplasty—the method of choice in the presence of an enlarged renal pelvis and crossing vessels. Eur Urol 42:268–275

    Article  PubMed  Google Scholar 

  16. Jarrett TW, Chan DY, Chambura TC, Fugita O, Kavoussi LR (2002) Laparoscopic pyeloplasty: the first 100 cases. J Urol 167:1253–1256

    Article  PubMed  Google Scholar 

  17. Pardalidis NP, Papatsoris AG, Kosmaoglou EV (2002) Endoscopic and laparoscopic treatment of ureteropelvic junction obstruction. J Urol 168:1937–1940

    Article  PubMed  Google Scholar 

  18. Rassweiler JJ, Subotic S, Teber D, Feist-Schwenk M, Frede T (2005) Laparoscopic pyeloplasty: the best treatment for UPJ obstruction? In: Dawson C, Muir G (eds) The evidence of urology. Puplishing Ltd, Shrewesbury-Malta, pp 287–304

    Google Scholar 

  19. Inagaki T, Rha KH, Ong AM, Kavoussi LR, Jarrett TW (2005) Laparoscopic pyeloplasty: current status. BJU Int 95:102–105

    Article  PubMed  Google Scholar 

  20. Moon DA, El-Shazly Chang CM, Gianduzzo TR, Eden CG (2006) Laparoscopic pyeloplasty: evolution of a new standard. Urology 67:932–936

    Article  PubMed  CAS  Google Scholar 

  21. Ravish LR, Nerli RB, Reddy MN, Amarkhed SS (2007) Laparoscopic pyeloplasty compared with open pyeloplasty in children. J Endourol 21:897–902

    Article  PubMed  CAS  Google Scholar 

  22. Shoma AM, El Nahas AR, Bazeed MA (2007) Laparoscopic pyeloplasty: a prospective randomized comparison between the transperitoneal approach and retroperitoneoscopy. J Urol 178:2020–2024

    Article  PubMed  Google Scholar 

  23. Rassweiler JJ, Subotic S, Feist-Schwenk M, Sugiono M, Schulze M, Teber D, Frede T (2007) Minimally invasive treatment of ureteropelvic junction obstruction: long-term experience with an algorhythm for laser endopyelotomy and laparoscopic retroperitoneal pyeloplasty. J Urol 177:1000–1005

    Article  PubMed  Google Scholar 

  24. Eden CG (2007) Minimally invasive treatment of ureteropelvic junction obstruction: a critical analysis of results. Eur Urol 52:983–989

    Article  PubMed  Google Scholar 

  25. Ost MC, Kaye JD, Guttman MJ, Lee BR, Smith AD (2005) Laparoscopic pyeloplasty versus antegrade endopyelotomy: comparison in 100 patients and a new algorithm for the minimally invasive treatment of ureteropelvic junction obstruction. Urology 66:47–51

    Article  PubMed  Google Scholar 

  26. Foley FEB (1937) A new plastic operation for stricture at the ureteropelvic junction: report of 20 operations. J Urol 38:643–648

    Google Scholar 

  27. Teber D, Tefekli A, Eskicorapci S, Gözen AS, Bujosevic S, Sugiono M, Stock C, Rassweiler JJ (2006) Retroperitoneoscopy: a versatile access for many urologic indications. Eur Urol Suppl 5:975–982

    Article  Google Scholar 

  28. Frede T, Stock C, Renner C, Budair Z, Abdel-Salam Y, Rassweiler J (1999) Geometry of laparoscopic suturing and knotting techniques. J Endourol 13:191–198

    PubMed  CAS  Google Scholar 

  29. Satava RM (2005) Identification and reduction of surgical error using simulation. Minim Invasive Ther Allied Technol 14:257–261

    Article  PubMed  Google Scholar 

  30. Clavien PA, Sanabria JR, Strasberg SM (1992) Proposed classification of complications of surgery with examples of utility in cholecystectomy. Surgery 111:518–522

    PubMed  CAS  Google Scholar 

  31. Permpongkosol S, Link RE, Su L-M, Romero FR, Bagga HS, Pavlovich CP, Jarret TW, Kavoussi LR (2007) Complications of 2,775 urological laparoscopic procedures: 1993 to 2005. J Urol 177:580–585

    Article  PubMed  Google Scholar 

  32. Tan BJ, Rastinehad AR, Marcovich R, Smith AD, Lee BR (2005) Trends in urtereropelvic junction obstruction managemet among urologists in the United States. Urology 65:260–264

    Article  PubMed  Google Scholar 

  33. Sugiono M, Teber D, Anghel G, Gözen AS, Stock C, Hruza M, Frede T, Klein J, Rassweiler JJ (2007) Assessing the predictive validity and efficacy of a multimodal training programme for laparoscopic radical prostatectomy. Eur Urol 51:1332–1340

    Article  PubMed  Google Scholar 

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There is no conflict of interest.

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Authors and Affiliations

  1. Department of Urology, SLK Kliniken Heilbronn, University of Heidelberg, Am Gesundbrunnen 20, 77074, Heilbronn, Germany

    Jens J. Rassweiler & Dogu Teber

  2. Department of Urology, Helios Klinik Müllheim, Müllheim, Germany

    Thomas Frede

Authors
  1. Jens J. Rassweiler
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  2. Dogu Teber
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  3. Thomas Frede
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Correspondence to Jens J. Rassweiler.

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Rassweiler, J.J., Teber, D. & Frede, T. Complications of laparoscopic pyeloplasty. World J Urol 26, 539–547 (2008). https://doi.org/10.1007/s00345-008-0266-z

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  • DOI: https://doi.org/10.1007/s00345-008-0266-z

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