Transumbilical laparoscopic single-site dismembered pyeloplasty for adolescents and children (3 cases report)

Yu Yanhong; Yang Junfeng; He Zhengyu; Xiao Minhui

doi:10.3969/j.issn.2095-5146.2016.05.009

Abstract：Objective: To discuss the efficiency of transumbilical laparoscopic single-site dismenbered pyeloplasty for adolescents.Methods: All 3 cases were female,average 10 years old,and all were diagnosed as ureteropelvic junction obstruction with heavy hydronephrosis.General anesthesia with intubation was performed,and the patients were put in 70° higher affected side lateral decubitus positions.A "∩" shaped periumbilical incision about 2.5 cm was made,and the "1 ring 3 channel" device was put into the abdominal cavity through the incision,then,30° camera and general laparoscopic instruments were used.The pressure of pneumoperitoneum was maintained under 1.33 kPa (10 mm Hg).Along the Toldt's line approach,the renal pelvis and ureter were dissected,and then the dismenbered pyeloplasty was performed.Results: All 3 cases were successfully operated on,and the operation time was 218 min,188 min and 205 min respectively.The drainage was pulled out 2 days after operation,and the patients were discharged 1 day later.There were no perioperative complications.Four to 6 weeks after the surgery,the stents were pulled out and IVP or CTU examinations were taken,and the imaging data showed that severe hydronephrosis was alleviated obviously with anastomotic stoma patency.The score was 2,3,and 3 respectively assessed by Vancouver scar system,and the navel scar was not obvious.Conclusions: It is feasible to perform the transumbilical laparoscopic single-site dismenbered pyeloplasty for adolescents and children with homemade "1 ring 3 channel" device and general laparoscopic instruments.The wound is aesthetic,but the learning curve is a little bit long,and the skill still needs to be improved.