ENDOUROLOGY & LAPAROSCOPY

Outpatient laparoscopic pyeloplasty
Rubinstein M, Finelli A, Moinzadeh A, Singh D, Ukimura O, Desai MM, Kaouk JH, Gill IS
Section of Laparoscopic and Robotic Surgery, Glickman Urological Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
Urology. 2005; 66: 41-3; discussion 43-4

• Objectives: To assess the feasibility of ambulatory laparoscopic pyeloplasty. Laparoscopic pyeloplasty aims to reproduce the excellent functional outcomes of open pyeloplasty while diminishing procedural morbidity.
• Methods: Six patients fulfilled specific inclusion criteria for outpatient laparoscopic pyeloplasty: informed consent, body mass index of 40 kg/m2 or less, primary ureteropelvic junction obstruction, uncomplicated laparoscopic surgery completed by 12:00 pm, and postoperative pain control by oral analgesics. All patients had a double-J ureteral stent placed cystoscopically before laparoscopic access. No drains were placed postoperatively.
• Results: All 6 patients successfully underwent laparoscopic dismembered pyeloplasty (3 left, 3 right) using the retroperitoneal (n = 5) or transperitoneal (n = 1) approach. The average patient age was 22 years. The mean surgical time was 223 minutes (range 165 to 270), the mean blood loss was 82 mL (range 10 to 250), and the mean postoperative hospital stay was 359 minutes (range 226 to 424). Postoperative analgesia comprised a mean of 6 mg morphine sulfate and 32 mg of ketorolac. No complications or readmissions occurred postoperatively. Intravenous urography and Lasix technetium-99m mercaptoacetyltriglycine renal scans documented resolution of obstruction. With long-term follow-up (mean 38.4 months), no recurrences have developed.
• Conclusions: We report our initial series of ambulatory laparoscopic pyeloplasty. In this well-selected patient population, outpatient pyeloplasty was feasible and safe.
  
  
• Editorial Comment
  Advancement in the area of laparoscopy allowed better and minimally invasive management of uretero-pelvic junction obstruction, departing from the less cosmetic but highly successful open technique. Other less invasive surgical techniques (i.e.; retrograde and anterograde endopyelotomy and Acucise endopyelotomy) offered an attractive outpatient setting but the success rates remained less than optimal. This article reveals that we have not explored all the benefits of minimally invasive laparoscopic surgery with an important caveat demonstrating that great results and low morbidity can only be achieved in high volume and experienced centers in laparoscopic surgery.

Dr. Fernando J. Kim
Chief of Urology
Denver Health Medical Center
Denver, Colorado, USA