Transmesocolic Approach for Left Side Laparoscopic Pyeloplasty: Comparison with Laterocolic Approach in the Initial Learning Period.
10.3349/ymj.2013.54.1.197
- Author:
Hyun Ho HAN
1
;
Won Sik HAM
;
Jang Hwan KIM
;
Chang Hee HONG
;
Young Deuk CHOI
;
Sang Won HAN
;
Byung Ha CHUNG
Author Information
1. Department of Urology and Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea.
- Publication Type:Original Article ; Comparative Study
- Keywords:
Hydronephrosis;
laparoscopy;
surgical procedures;
minimally invasive;
ureter;
ureteral obstruction
- MeSH:
Adolescent;
Adult;
Aged;
Child;
Child, Preschool;
Colon/surgery;
Disease-Free Survival;
Female;
Humans;
Infant;
Kidney/*surgery;
Kidney Pelvis/*surgery;
Laparoscopy/*methods;
Male;
Middle Aged;
Pain, Postoperative;
Postoperative Period;
Reconstructive Surgical Procedures/methods;
Time Factors;
Ureter/surgery;
Ureteral Obstruction/surgery;
Urologic Surgical Procedures/*methods;
Young Adult
- From:Yonsei Medical Journal
2013;54(1):197-203
- CountryRepublic of Korea
- Language:English
-
Abstract:
PURPOSE: To evaluate the outcome of transmesocolic (TMC) laparoscopic pyeloplasty compared with conventional laterocolic procedure for surgeons with limited experience. MATERIALS AND METHODS: We started laparoscopic pyeloplasty for ureteropelvic junction obstruction in 2009. Since then, 21 patients of left side disease have undergone this surgery in our institution. To access the left ureteropelvic junction, we used the conventional laterocolic approach in 9 patients, while the transmesocolic approach was used in the remaining 12 patients, and perioperative results and follow-up data were then compared. RESULTS: The mean operative time using the transmesocolic approach was significantly shorter than the conventional laterocolic approach (242 vs. 308 min, p=0.022). Furthermore, there was no complication or open conversion. Postoperative pain was significantly decreased in the TMC group (2.8 vs. 4.0 points, measured using the visual analogue scale on the first postoperative day, p=0.009). Postoperative complications were encountered in two patients. All patients were symptom-free after 1 year of follow-up, and radiologic success rates for each group were 92 and 89%, respectively. CONCLUSION: Direct exposure of the ureteropelvic junction via the mesocolon saves time during the colon mobilization procedure. The approach is safe and feasible even for surgeons with limited experience, and has success rates similar to those of the conventional laterocolic approach.
