Purpose: To compare the transperitoneal and the retroperitoneal approach in the laparoscopic management of pelviureteric junction (PUJ) obstruction, and to find out which approach is preferable during the learning curve period at two different urologic centers. Materials and Methods: We retrospectively evaluated 50 consecutive laparoscopic pyeloplasties performed by two urologists from different urologic centers during their learning curve period in laparoscopy. Each surgeon used a different approach: transperitoneal (group A) or retroperitoneal (group B). Timing for patient positioning, access to the operating field, ureter and PUJ isolation, PUJ suturing, total time of the surgery procedure and blood loss were recorded to compare the transperitoneal with the retroperitoneal approach. Intraoperative complications and perioperative morbidity were also reported. Results: 22 procedures were performed using the transperitoneal method (group A) and 28 using the retroperitoneal method (group B). Significant differences between groups A and B were observed in terms of time for access to the operating field (mean 25 and 15 min, respectively, p < 0.05), time for suturing the PUJ (mean 57 and 103 min, respectively, p < 0.001), and total operative time (mean 127 and 201 min, respectively, p < 0.002). No statistical differences were observed for any other parameters. Average follow-up was 10 and 11 months for groups A and B; no statistical differences were observed. Conclusions: We suggest that young urologists during the learning curve for laparoscopy should perform laparoscopic pyeloplasty using a transperitoneal route. In expert hands, both transperitoneal and retroperitoneal approaches are feasible, and the choice depends on personal preference.

Keywords:
Laparoscopy, Pyeloplasty, Retroperitoneum
1.
Hafron J, Kaouk JH: Technical advances in urological laparoscopic surgery. Expert Rev Med Devices 2008;5:145-151.
2.
Bauer JJ, Bishoff JT, Moore RG, Chen RN, Iverson AJ, Kavoussi LR: Laparoscopic versus open pyeloplasty: assessment of objective and subjective outcome. J Urol 1999;162:692-695.
3.
Schuessler WW, Grune MT, Tecuanhuey LV, Preminger GM: Laparoscopic dismembered pyeloplasty. J Urol 1993;150:1795-1799.
4.
Kavoussi LR, Peters CA: Laparoscopic pyeloplasty. J Urol 1993;150:1891-1894.
5.
Janetschek G, Peschel R, Altarac S, Bartsch G: Laparoscopic and retroperitoneoscopic repair of ureteropelvic junction obstruction. Urology 1996;47:311-316.
6.
Parkin J, Evans S, Kumar PVS, Timoney AG, Keeley FX Jr: Endoluminal ultrasound before retrograde endopyelotomy: can the results match laparoscopic pyeloplasty? BJU Int 2003;91:389-391.
7.
Pardalidis NP, Papatsoris AG, Kosmaoglou EV: Endoscopic and laparoscopic treatment of uretero-pelvic junction obstruction. J Urol 2002;168:1937-1940.
8.
Eden CG, Cahill D, Allen JD: Laparoscopic dismembered pyeloplasty: 50 consecutive cases. BJU Int 2001;88:526-531.
9.
Jarrett TW, Chan DY, Charambura TC, Fugita D, Kavoussi LR: Laparoscopic pyeloplasty. The first 100 cases. J Urol 2002;167:1253-1256.
10.
Turk IA, Davis JW, Winklemann B, Deger S, Richter F, Fabrizio MD, Schönberger B, Jordan GH, Loening SA: Laparoscopic dismembered pyeloplasty - the method of choice in the presence of an enlarged renal pelvis and crossing vessels. Eur Urol 2002;42:268-275.
11.
Soulie M, Salomon L, Patard JJ, Mouly P, Manuta A, Antiphen P, Lobel B, Abbou CC, Plante P: Extraperitoneal laparoscopic pyeloplasty: a multicentre study of 55 procedures. J Urol 2001;166:48-50.
12.
Shoma AM, El Nahas AR, Bazeed MA: Laparoscopic pyeloplasty: a prospective randomized comparison between the transperitoneal approach and retroperitoneoscopy. J Urol 2007;178:2020-2024.
13.
Davenport K, Minervini A, Timoney AG, Keeley FX Jr: Our experience with retroperitoneal and transperitoneal laparoscopic pyeloplasty for pelvi-ureteric junction obstruction. Eur Urol 2005;48:973-977.
14.
Abuanz S, Gamé X, Roche JB, Guillotreau J, Mouzin M, Sallusto F, Chaabane W, Malavaud B, Rischmann P: Laparoscopic pyeloplasty: comparison between retroperitoneoscopic and transperitoneal approach. Urology 2010;76:877-881.
15.
El-Shazly MA, Moon DA, Eden CG: Laparoscopic pyeloplasty: status and review of literature. J Endourol 2007;21:673-678.
16.
Murphy D, Challacombe B, Rane A: Laparoscopic reconstructive urology. J Min Access Surg 2005;1:181-187.
17.
Ramakumar S, Lancini V, Chan DY, Parsons JK, Kavoussi LR, Jarrett TW: Laparoscopic pyeloplasty with concomitant pyelolithotomy. J Urol 2002;167:1378-1380.
18.
Frede T, Stock C, Rassweiller JJ, Alken P: Retroperitoneoscopic and laparoscopic suturing: tips and strategies for improving efficiency. J Endourol 2000;14:905-913.
© 2012 S. Karger AG, Basel
2012
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