CU 50. Laparoscopic pyeloplasty: A comparison between the transperitoneal and the retroperitoneal approach during the learning curve
Clinical Urology

CU 50. Laparoscopic pyeloplasty: A comparison between the transperitoneal and the retroperitoneal approach during the learning curve

Hongjian Zhu1, Cheng Shen2, Xuesong Li2, Xuren Xiao1, Xianglong Chen1, Qingjiang Zhang1, Hua Wang1, Liqun Zhou2

1Department of Urology, General Hospital of Armed Police Forces of China, Beijing, China; 2Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, Beijing, China


Purpose: To compare the transperitoneal approach and the retroperitoneal approach in the laparoscopic management of pelvi-ureteric junction obstruction (PUJO), at two different urologic centers during the learning curve period.

Materials and Methods: We prospectively evaluated 50 consecutive laparoscopic pyeloplasty performed by two different urologists during their learning cur ve period in laparoscopy. Each surgeon used a different approach: Transperitoneal (group A) and retroperitoneal (group B). Timing for patient positioning, trocar placement and access to the operating field, ureter and pelvi-ureteric junction isolation, pelvi-ureteric junction suturing were recorded to compare the transperitoneal with the retroperitoneal method. Intraoperative complications and perioperative morbidity were also reported.

Results: Twenty-two procedures were performed using the transperitoneal method (group A) and twenty-eight using the retroperitoneal method (group B). Significant differences between group A and B were observed in terms of time for access to the operating field (mean times 25 and 15 min, respectively, P<0.05); time for suturing the pelviureteric junction (mean times 57 and 103 min, respectively, P<0.001); and total operative time (mean times 127 and 201 min, respectively, P<0.002). No statistical differences were observed for any other parameters. Blood loss was minimal in all cases (mean losses 85 and 90 mL, respectively, P=0.834); and hemotransfusion was not needed by either group. Average follow-up was 10 and 11 months for groups A and B, no statistical differences were observed.

Conclusions: We suggest that urologists in training for laparoscopy perform laparoscopic pyeloplasty using a transperitoneal route. In expert hands, both transperitoneal and retroperitoneal approaches are feasible, and the choice depends on personal preference.

Key words

Transperitoneal approach; retroperitoneal approach; PUJO

DOI: 10.3978/j.issn.2223-4683.2012.s064

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