Authors: Jens J Rassweiler Dogu Teber Thomas Frede
Publish Date: 2008/05/10
Volume: 26, Issue: 6, Pages: 539-
Abstract
With the development of new videoendoscopic techniques like endopyelotomy laparoscopy and retroperitoneoscopy the treatment of UPJO has become less invasive The complications and learning curve of laparoscopic pyeloplasty are presented together with recommendations for adequate managementBased on the personal experience with 189 cases of retroperitoneoscopic pyeloplasty a literature review PubMed was performed focussing on complication and success rates of the procedure Intraoperative incidents were analysed using the Satavaclassification postoperative complications according to the Clavienclassification The metaanalysis focussed on the experience of the 3 largest and 2 smaller series representing a cohort of 601 patientsIntraoperative incidents ranged from 20 to 23 in large series mostly without consequences for the patient including ligation of lower pole artery loss of needle hyperkapnia cutting of DJstent colonic injury and port site bleeding The conversion rate was mainly due to inability to access UPJ or to accomplish the anastomosis ranging between 05 and 55 Postoperative complications occured between 129 and 158 in large series A total of 54–10 represented Grade IIIcomplications such as urine leakage haematoma colonic lesion and stone formation Recurrent UPJstenosis requiring reintervention was seen in 35–48 In all three large series complications were part of the learning curveLaparoscopic pyeloplasty has been proven safe and effective with comparable results to open surgery The experience of pioneering centres with incidence and management of complications will be used by next generations of laparoscopic urologic surgeons to shorten their learning curve
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