Articles

Surgery in Motion

Retroperitoneal Laparoscopic Pyeloplasty in Children: Long-Term Outcome and Critical Analysis of 10-Year Experience in a Teaching Center

By: Thomas Blanca, Cecile Mullera, Hendy Abdoulb, Stoyen Peeva, Annabel Paye-Jaouena, Matthieu Peycelona, Elisabeth Carricaburua and Alaa El-Ghoneimia lowast

European Urology, Volume 63 Issue 1, March 2013, Pages 565-572

Published online: 01 March 2013

Keywords: Pyeloplasty, Retroperitoneoscopy, Children, Learning curve, Laparoscopy

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Abstract

Background

Laparoscopic pyeloplasty in children remains controversial and is not included in most pediatric urology centers because of technical difficulties and lack of long-term results.

Objective

To critically analyze our 10-yr experience with the retroperitoneal approach (RA), with a particular interest on the impact of the learning curve in a teaching center.

Design, setting, and participants

Patients who underwent pyeloplasty between 1999 and 2010 at our institution were reviewed (n=390). The diagnosis of ureteropelvic junction obstruction was confirmed by ultrasound and technetium Tc 99m mercaptoacetyltriglycine-3 renal scan or magnetic resonance imaging; the same criteria were used to evaluate the outcome. The lateral RA was selected in children >1 yr of age without abnormal migration or fusion of the kidney (n=104).

Surgical procedure

Dismembered pyeloplasty and anastomosis were performed using running monofilament 5-0 or 6-0 absorbable suture. All were drained by double-J stent except 20 cases drained by external transanastomotic stent.

Outcome measurements and statistical analysis

We assessed intra- and postoperative morbidity and analyzed the teaching of technique and learning curve. Data are expressed as medians and interquartile range (25th, 75th percentiles) for quantitative variables.

Results and limitations

Median age was 6.2 yr (2.2–10.3). Thirty-three patients had crossing vessels. Median operative time was 185min (160–235). Median hospital stay was 2 d (1–2). Redo pyeloplasty was needed in only two children (2%). Median follow-up was 2.1 yr (1.4–4.1). Operative time was <3h after 35 cases. After 30 cases performed by the same surgeon, standardization of the technique was feasible, which helped in the teaching process because 50% of the final 30 cases were done by trainees.

Conclusions

Retroperitoneal dismembered laparoscopic pyeloplasty is a safe, reliable, and efficient procedure with an excellent outcome in selected children according to their indications and age, and the experience of the surgical team. Even if the transmission to trainees is successful, it is still a long learning process and remains a challenging task for a teaching center.

Take Home Message

Retroperitoneal laparoscopic pyeloplasty is a safe and reliable procedure with an excellent outcome in selected children according to indications, age of the patient, and experience of the surgical team. In a teaching center, standardization of the technique and a constructive training program are highly recommended.

Keywords: Pyeloplasty, Retroperitoneoscopy, Children, Learning curve, Laparoscopy.

Footnotes

a Department of Pediatric Surgery and Urology, Robert Debré University Hospital, AP-HP, University of Paris VII-Denis Diderot, Sorbonne Paris Cité, Paris, France

b Department of Epidemiology, Robert Debré University Hospital, AP-HP, University of Paris VII-Denis Diderot, Sorbonne Paris Cité, Paris, France

lowast Corresponding author. Department of Pediatric Surgery and Urology, Robert Debré University Hospital, AP-HP University of Paris VII-Denis Diderot, 48, boulevard Sérurier, 75935 Paris Cedex 19, France. Tel. +33 1 4003 2159; Fax: +33 1 4003 4762.

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