What is laparoscopic pyeloplasty?
Pyeloplasty is the surgical correction of an obstruction between the kidney and the tube (ureter) that takes urine to the bladder. This condition, also known as an ureteropelvic junction obstruction (UPJ), was described by Friedrich Trendelenburg in 1886. Since that time, a number of advances in techniques to correct UPJ obstruction have been made, and one of these modern approaches is laparoscopic pyeloplasty.
Over the past decade, laparoscopic pyeloplasty has gained acceptance by mirroring the principles and results of open surgery without the associated morbidity of a flank incision.
However, pure laparoscopic pyeloplasty requires the necessary skills to perform precise intracorporeal suturing (stitching done inside the body). The introduction of computer-assisted robotic surgical systems has enhanced the ability to perform intracorporeal suturing with a short learning curve and high precision.
Reported small series comparing standard laparoscopic pyeloplasty to robotic pyeloplasty revealed shorter total operative time and UPJ anastomosis times in the latter with excellent success rates and minimal complications.
What advantages does laparoscopic pyeloplasty offer?
Laparoscopic pyeloplasty boasts a number of advantages over a traditional open pyeloplasty.
- Reduced hospital stay (one day in younger, healthy patients) and faster healing
- Less postoperative pain and less need for pain medication
- Quicker return to normal activity and work
- Smaller incisions and less scarring
How long does laparoscopic pyeloplasty take?
Laparoscopic pyeloplasty takes approximately 2 to 3 hours, and the hospital stay is usually just overnight.
What outcomes should I expect from a laparoscopic pyeloplasty?
Cleveland Clinic's surgical team has had excellent clinical and radiologic success rates in patients who require a laparoscopic pyeloplasty.
Robotic-assisted dismembered pyeloplasty can be performed efficiently by the retroperitoneal laparoscopic technique. Our surgical outcomes are comparable to previously published laparoscopic and transperitoneal robotic-assisted dismembered pyeloplasty series in adults with excellent clinical and radiologic success rates.
In just a year, between February 2004 and March 2005, ten adult patients with unilateral ureteropelvic junction (UPJ) obstruction underwent robotic-assisted retroperitoneoscopic Anderson-Hynes dismembered pyeloplasty. UPJ obstruction was primary in six patients and secondary in four patients after failed endopyelotomy. Dismembered pyeloplasty was performed utilizing a retroperitoneal approach (developed by balloon dissection). Three retroperitoneal laparoscopic ports were placed for the robot, and a fourth port was used by the assistant. Robotic-assisted laparoscopic technique was utilized to perform the entire procedure in all cases.
All cases (seven right, three left) were successfully completed using the robot without conversion to conventional laparoscopic or open technique.
How long has Cleveland Clinic been performing laparoscopic pyeloplasties?
Cleveland Clinic has been performing laparoscopic pyeloplasties since 2001. Cleveland Clinic now offers laparoscopic options for a majority of kidney surgeries and has, by far, the most experience with laparoscopic kidney surgery in the United States.
What happens before a laparoscopic pyeloplasty?
Before your laparoscopic pyeloplasty, you’ll be asked to stop taking aspirin, NSAIDS (including Advil, Ibuprofen, and Aleve) or other blood thinning medications at least a week prior to surgery. Because certain herbal medications or supplements also increase risk of bleeding during surgery, your doctor will advise you which supplements to cease using before surgery. Ask your doctor about using other medications such as antibiotics or blood pressure medication prior to surgery. Do not discontinue any medication without being advised by your doctor to do so.
Other medications such as Warfarin or Plavix also may need to be ceased at least 5 days before surgery to decrease bleeding risk.
Your doctor will also ask you to stop smoking. Besides the negative health consequences that smoking has, smoking can lead to higher risks both during and after surgery. Tobacco has been proven to slow down the healing process and decrease the effectiveness of the immune system.
Your diet will have to change the day prior to surgery most doctors recommend that you should follow a clear liquid diet starting the morning before your surgery.This includes juices without pulp, soup broth, and Jell-O.
It is also important to arrange for someone to care for you after surgery as returning to normal activity is not recommended immediately after surgery.
What happens during a laparoscopic pyeloplasty?
Unlike a conventional open pyeloplasty, laparoscopic pyeloplasty surgery requires only several small incisions. Through these incisions, a surgeon uses a powerful endoscope – a tiny camera – and specialized surgical instruments to conduct the operation and repair the kidney.
After the small incisions are made, the kidney is dissected and exposed. The surgeon will find the obstruction and excise (remove) it. If a patient has developed kidney stones as a result of the UPJ, this is a potential time to treat those as well.The ureter and renal pelvis ends are spatulated and reconnected using sutures to allow for a wide connection. A drain is placed at the end of the surgery and is generally removed within 24-48 hours. The indwelling ureteral stent is maintained for four weeks and then removed in the clinic during a postoperative visit.
What happens after a laparoscopic pyeloplasty?
After the pyeloplasty, you’ll be guided into a recovery room where nurses will monitor your condition until you are awake and stable. You’ll be given medication for pain as needed (some patients will have an epidural, others will receive narcotics as needed, depending on the patient).
Our expert staff will provide you with Intravenous (IV) fluids to provide you nutrition until your digestive track recovers enough to take solid food. If you eat or drink too soon after surgery, you can experience nausea, vomiting, or other side effects. Our nurses will encourage you to sit up and to walk around as soon as possible after surgery. Doing so has several benefits. It encourages blood flow (which helps healing and prevents blood clots) and promotes oxygen flow (to prevent pneumonia and help healing).
After you are cleared to go home you’ll be prescribed medication to manage pain, treat potential constipation, and to prevent infections (antibiotics).