Laparoscopic pyeloplasty: The retroperitoneal approach is suitable for establishing a de novo practice

Background: Laparoscopic dismembered pyeloplasty has become the "gold-standard" procedure for pelviureteric junction (PUJ) obstruction but consists of a steep learning curve especially via the retroperitoneal route.
Aims: To examine the feasibility and safety of introducing this technique via the retroperitoneal approach to a laparoscopic naοve center.
Settings and Design: A retrospective data analysis of a single surgeon′s (NEO) series from a large UK teaching hospital.
Materials and Methods: The notes and imaging of all patients who underwent pyeloplasty for PUJ obstruction by NEO during a five-year period were reviewed.
Statistical Analysis: Parametric and nonparametric data are presented analyzed with Excel XP (Microsoft, Redmond, WA, USA).
Results: Our series consists of 67 patients. Three ports were used in 47/57 (82%), and the antegrade technique for stent insertion was utilized in 41/67 (61%). Median time to drink, eat, and mobilize was one day (range one to two), and to discharge three days (range three to four). Two patients required conversion to an open procedure, and two developed intraoperative complications. Postoperative complications at 30 (three major, seven minor) and 90 days (three major, three minor) are presented. With median follow-up of 15 months 61/65 (94%) patients were unobstructed, and 57/63 (90%) of patients were pain-free. Two patients re-obstructed requiring further surgery.
Conclusions: Analysis of our series of patients illustrates that adopting a policy of retroperitoneal laparoscopic pyeloplasty for primary PUJ obstruction is feasible without compromising patient safety or functional results. There is no need to breach the peritoneum to facilitate the learning curve.

Keywords
Clinical outcome, primary laparoscopic pyeloplasty, PUJ obstruction, retroperitoneal approach