References
No. Pt
Approach
Type/correction (no)
Mean hrs operative time
Mean days hospitalised follow up
Mean months
% success
No. conversions (%)
No. complications (%)
Jarrett et al. [4]
100
TP
DM (71) Y-V plasty (20,other 9)
4.4 (2–8)
3.3 (2–8)
26.4 (1–72)
96
0 (0)
13 (13)
Janetschek et al. [5]
65
RP, RP
Fengerplasty
2.1
–
25 (4–60)
98
0 (0)
7 (12)
Chen et al. [6]
57
–
DM (44), Y-V plasty (13)
4.3 (2.3–8.0)
3.3 (2–6)
17.2 (1–37)
96
0 (0)
7 (12.7)
Soulfe et al. [7]
55
TP
DM (48),Fenger plasty (7)
3.1 (1.7–4.3)
4.5 (1–14)
14.4 (6–43.6)
87
3 (5.5)
2 (4)
Eden et al. [8]
50
RP
DM (50)
2.7 (2–4)
2.6 (2–7)
18.8 (3–72)
98
2 (4)
1 (2)
Turk et al. [9]
49
RP
DM (49)
2.7 (1.5–4)
3.7 (3–6)
23.2 (1–53)
98
0 (0)
–
Ramalingam et al. [10]
129
TP (71)
TM (49)
RP (9)
DM (113)
NDM-Fenger (12)
Y-V plasty (5)
Culp Plasty (6)
3.2–4
3.5 (2.7–4.6)
36 (3–68)
97 %
3
4 (6)
1.5–2.5
3.5
100 %
Viswajeet singh et al. [11]
112
TP,RP
DM (TP-56, RP- 56)
162 ± 18
188 ± 24
3.39 ± 0.28
3.14 ± 0.36
30.75 ± 4.85
30.99 ± 5.59
96.4
96.6
1
2
14.8
Moon et al. [12]
170
TP
DM
140
3.2
12
96.2 %
0.6 %
7.1 %
Castillo et al. [13]
80
TP
DM
93.2
Singh et al. [14]
142
TP
DM
145
3.5
30
96.8 %
2 (∙)
19 (∙)
Inagaki et al. [15]
147
TP
106DM, 28 YV, 11 Fenger, 2 Culp
246
3.1
24
95 %
0
11 (∙)
Vessel crossing UPJ, difficulties in stenting, Horse shoe kidney with UPJ obstruction and Culp flap pyeloplasty have been illustrated.
5.5 Transperitoneal Dismembered Pyeloplasty
Fig. 5.1
CT image- right UPJ obstruction
Fig. 5.2
Ports position
Fig. 5.3
Initial laparoscopic view showing the bulging right renal pelvis
Fig. 5.4
Ureter is identified as a tubular structure, with characteristic vascular plexus, in the retroperitoneum
Fig. 5.5
Ureter is traced proximally till the dilated pelvis. Dissection of ureter is done outside the adventitial layer, preserving the vascular arcade
Fig. 5.6
Pelvi ureteric junction is identified as a transition between dilated pelvis and narrow ureter. Oblique pyelotomy done initially along the lateral aspect
Fig. 5.7
Ureter is spatulated laterally, using curved scissors or Potts scissors
Fig. 5.8
Spatulation is complete, when the normal calibre ureter with rugosities are seen. A ‘give’ may be felt when spatulation extends from the narrow segment to normal segment
Fig. 5.9
Pyelotomy is extended with a medial spatulation. A small strip is preserved along the posterior wall for better initial orientation
Fig. 5.10
Pelvi ureteric anastomosis started with the initial suture outside-in from the apex of pelvis using 4-0 PDS suture
Fig. 5.11
Corresponding suture is taken through the apex of the ureteric spatulation inside-out
Fig. 5.12
Preplaced stent is being repositioned
Fig. 5.13
Apical suture in place
Fig. 5.14
Dividing the posterior pelvic wall strip completes division of PUJ
Fig. 5.15
Apical suture is continued in the posterior layer
Fig. 5.16
Image shows the completed posterior wall suturing
Fig. 5.17
Anterior wall suturing is done next, with the similar suture
Fig. 5.18
Continuous suturing of anterior wall in progress
Fig. 5.19
Final stages of pelvi ureteric anastomosis
Fig. 5.20
Completed pyeloplasty
Fig. 5.21
Perinephric fat used as cover for anastomosis
Fig. 5.22
Drain placed through lower port
5.6 Transperitoneal Non Dismembered Pyeloplasty
Fig. 5.23
Left colon being reflected along line of Toldt
Fig. 5.24
Ureter identified in the retroperitoneum with its characteristic features
Fig. 5.25
Ureter traced proximally till pelvis
Fig. 5.26
Pelvi ureteric junction identified and dissected all around preserving adventitia around the ureter
Fig. 5.27
Pyelotomy being done in the shape of ‘V’ with the apex of V just proximal to PUJ
Fig. 5.28
Pyelotomy completed
Fig. 5.29
Ureteric spatulation being done as the vertical limb of ‘Y’
Fig. 5.30
Completed ‘Y’ incision
Fig. 5.31
Apical suture through the ureter with 4-0 polyglactin
Fig. 5.32
Corresponding suture through the apex of pelvic flap
Fig. 5.33
Apical suture in place
Fig. 5.34
Continuous suturing of lateral margin of flap in progress
Fig. 5.35
Lateral margin suturing in progress
Fig. 5.36
Lateral margin suturing completed
Fig. 5.37
Lateral wall suture seen through the inner aspect of pelvis
Fig. 5.38
Stent being inserted antegrade
Fig. 5.39
Medial margin suturing in progress
Fig. 5.40
Medial margin suturing in progress
Fig. 5.41
Medial margin suturing completed
Fig. 5.42
Completed ‘Y’ – ‘V’ plasty
Fig. 5.43
Diagrammatic representation of Y – V plasty
5.7 Transmesocolic Pyeloplasty
Fig. 5.44
RGP showing left UPJ narrowing
Fig. 5.45
Ports position
Fig. 5.46
Bulging pelvis seen through the mesocolon
Fig. 5.47
Incision of the mesocolon over the bulge, preserving the mesocolic vessels
Fig. 5.48
Pelvis seen through the mesocolic window
Fig. 5.49
Pelvis and upper ureter dissected through the mesocolic window and pelviureteric junction delineated
Fig. 5.50
Sling placed around the ureter for identification and retraction
Fig. 5.51
Mesocolon tacked to the abdominal wall
Fig. 5.52
Oblique pyelotomy in progress
Fig. 5.53
Anterior layer of pelvis incised completely
Fig. 5.54
Pyelotomy about to be completed. Note preplaced guide wire
Fig. 5.55
Lateral spatulation of ureter in progress
Fig. 5.56
Ureteric spatulation completed – beyond the narrowing
Fig. 5.57
Initial suture through the pelvis – outside-in using 4–0 Polydioxanone suture
