Laparoendoscopic Single-Site Pyeloplasty with Concomitant Pyelolithotomy Using Flexible Cystoscope

Abstract

Introduction:

Laparoscopic pyeloplasty has been demonstrated the feasibility with similar success rates compared with open surgery, but with decreased postoperative pain and hospital stay. ¹ Recently, less invasive surgical technique, laparoendoscopic single-site surgery (LESS), has been developed. ² Clinical feasibility and usefulness of LESS kidney surgery already has been demonstrated in comparative study with conventional laparoscopic surgery. ³ Herein we report a patient who benefited from innovative LESS pyeloplasty with concomitant pyelolithotomy.

Materials and Methods:

A 36-year-old man presented with left ureteropelvic junction obstruction and ipsilateral multiple calyceal stones. He had left flank pain for 3 months. He was found to have ureteropelvic junction obstruction with multiple calyceal stones at other hospital using kidneys, ureters, and bladder radiograph and computed tomography. He underwent umbilical LESS pyeloplasty with concomitant pyelolithotomy using flexible cystoscope. We used OCTO^™ Port (Model OT303S-D; Dalim SurgNet, Seoul, Korea) as an access device and we did not use any accessory port during the whole procedure. We also used 5-mm flexible tip laparoscope and 14F flexible cystoscope for observation. We used LaparoAngle^™ (Cambridge Endoscopic Devices, Framington, MA) to create triangulation, along with standard rigid laparoscopic instruments.

Results and Conclusions:

Total operative time was 290 min, including 80 min for pyelolithotomy, and estimated blood loss was minimal. We removed a total of 22 stones, and there was no intra or immediate postoperative complication. Kidneys, ureters, and bladder radiograph at recovery room showed three small residual stones and well-positioned ureteral stent. On postoperative day 2, drain was removed. On postoperative day 4, the patient was discharged. Previously, LESS pyeloplasty series has been published. ⁴ In this study LESS pyeloplasty was feasible and all measured perioperative outcomes were similar to conventional laparoscopic pyeloplasty. Herein we presented the world's first case in which LESS pyeloplasty with synchronous pyelolithotomy was applied. The surgery and postoperative recovery were uncomplicated. The greatest advantage was that only a small, single incision at the umbilicus was used for the surgery, and this surgical approach looks feasible.

No competing financial interests exist.

Runtime of video: 7 mins 30 secs