Posterior One-Trocar-Assisted Pyeloplasty

Abstract

Introduction Ureteropelvic junction obstruction is the most common pediatric obstructive uropathy. Retroperitoneal laparoscopic-assisted dismembered pyeloplasty (OTAP) combines the advantages of a retroperitoneal approach with the high success rate of the open technique. A modification of the OTAP, using a posterior muscle-sparing incision to approach the kidney, is described. Surgical technique With the patient placed in prone position, a transverse 15-mm-long skin incision is made. A 12-mm balloon Hasson trocar with operative telescope is inserted after the Gerota’s fascia has been opened. The ureteropelvic junction is exteriorized and a traditional dismembered pyeloplasty is performed. Discussion The posterior approach allows a quick and easy access to the renal lodge and does not require the incision of abdominal wall muscles and the parietal peritoneum does not interfere with the procedure. Furthermore, the exteriorization of the ureteropelvic junction is easy, because the space between its natural position and the skin is short, consisting only in subcutaneous tissue. Conclusion The posterior modified approach to the kidney for OTAP procedure is a good option, as an alternative to lumbotomic lateral access, allowing a good visualization of the kidney lodge, together with easy and rapid exteriorization of the ureteropelvic junction.