On trocar assisted pyeloplasty: initial experience and codification of a technique

Introduction The Anderson-Hynes pyeloplasty is still considered the gold standard for the surgical treatment of the urete- ropelvic junction obstruction (UPJO). However the mu- scular trauma and the skin incision can be considerable. Laparoscopic and retroperitoneoscopic pyeloplasty have been proposed but concerns have been expressed regar- ding those techniques. In case of retroperitoneal ap- proach in children, the small operative space and the technical difficulties have limited the application of this technique, while in case of laparoscopy, a transperitoneal technique is used to treat a retroperitoneal disease. We report our initial experience with a videoassisted retrope- ritoneoscopic approach, the “one trocar assisted pyelo- plasty” (OTAP) in the treatment of UPJO in children. Materials and methods Three males children, respectively 2, 5 and 8months old, with impaired left renal function underwent surgical treatment for UPJO. They were positioned in a lateral kidney position and the Gerota’s fascia was bluntly rea- ched and opened via a flank 12 mm incision. The renal pelvis was anteriorly approached using a 10 mm opera- tive telescope. The UPJ was exteriorized and a dismem- bered pyeloplasty performed. Nor transanastomotic tutor either pyelic drain was left. The bladder catheter was re- moved after 24 hours. Results The patients were discharged after four days without early complications. The cosmetic results are excellent. No complication is seen at the clinical and US follow-up after 1 and 3 months. Discussion In our opinion the OTAP could be considered as a safe and feasible alternative to the laparoscopic or retro- peritoneoscopic pyeloplasty. Nevertheless more expe- rience and a longer follow-up are needed.