UroToday - Over time, laparoscopic techniques have evolved and are now state-of-the-art for many urologic procedures. While potentially less experienced in laparoscopic surgery than their general surgical colleagues, urologists are now able to perform laparoscopic procedures for many of their surgical candidates. Nevertheless there are certain procedures that pose significant challenges and pitfalls.

Laparoscopic Haynes-Anderson dismembered pyeloplasty involving intracorporeal knot tying, constitutes a challenge for one's skills. Dr. Thomas Jarrett and colleagues, in a highly skilled referral center, accrued considerable experience performing the procedure on a significant number of patients 1. Acknowledging that laparoscopic pyeloplasty tends to become a standard approach, at least for large centers, we add our experience with the utilization of the technique in a case of a duplicated collecting system bearing obstruction of the lower ureteropelvic junction (UPJ).

A standard dismembered pyeloplasty was performed recognizing the crossing vessels and medial displacement of the respective ureter. Of special importance is the issue of "healthy" UPJ and ureter protection. Since no extensive experience is reported with this particular setting, no absolute recommendations can be made. However, it is the authors' impression that delicate medial displacement of both ureters is sufficient for their preservation.

Our experience remains to be confirmed in other settings and may then become the recommended approach for this unusual patient population.

Reference

1. Jarrett TW, Chan DY, Charambura TC, Fugita O, Kavoussi LR. Laparoscopic pyeloplasty: the first 100 cases. J Urol 2002; 167: 1253-56

Theodoros Kapetanakis, MD as part of Beyond the Abstract on UroToday

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