One-trocar-assisted pyeloplasty

Abstract

Purpose: One-trocar-assisted pyeloplasty (OTAP) is a recent, not yet well-known surgical technique for the treatment of ureteropelvic junction obstruction, described for the first time by El Gohary in 2004. The first step of this procedure is to identify the pyeloureteral junction (PUJ) through a laparoscopic approach using one trocar, and the pelvic-ureteric anastomosis is carried out in "open" surgery. We present our experience with OTAP, an innovative technique in pediatric surgery.

Materials and methods: From October 2005 to December 2009, 39 patients (27 males and 12 females) with UPJ obstruction underwent OTAP. The age of these patients ranged from 1.5 month to 18 years (mean age: 5.3 years), especially 18 of them were under the age of 1 year. Despite the age difference, the technique was carried out using the same procedure. A retroperitoneal space was created and the PUJ was identified and dissected from the surrounding tissue with one trocar (10 mm) and an operative telescope, then the PUJ was brought up through the trocar site, and the anastomosis was performed using 6/0 absorbable sutures. Any redundant renal pelvis was reduced where needed.

Results: All patients successfully underwent OTAP. An aberrant crossing vessel was found in 8 patients. The mean operative time was 78 minutes (range: 65-90 minutes) and the mean hospital stay was 2.5 (2-4) days. All children returned to full activity within 7 days. The follow-up mean was 24 months (range 1-49); all patients were asymptomatic.

Conclusion: Our medium-term results confirm that OTAP is an innovative technique, which allows a safe approach for children and, moreover, it is applicable to the entire range of ages. However, a good practical experience is required.