Laparoscopic unilateral pyeloplasty

Laparoscopic unilateral pyeloplasty is a less invasive surgical procedure that aims at the treatment of ureteropelvic junction (UPJ) obstruction in one side (left or right kidney). This is done to clear out the blockage of the renal pelvis and ureter to allow the normal flow of urine and avoid kidney damage.

What Is Laparoscopic Unilateral Pyeloplasty?

It is a keyhole operation during which the surgeon excises the blocked part of the UPJ and reconstructs the junction with the help of small incisions and a camera-directed procedure.

It is commonly advised for:

• Congenital UPJ obstruction
• Crossing ships that bring about congestion.
• Obstruction of post-inflammatory or stone origin.
• Repeat infections or hydronephrosis.

Unilateral laparoscopic pyeloplasty surgery

Unilateral laparoscopic pyeloplasty is a minor or minimally invasive surgery that is done to treat ureteropelvic junction (UPJ) obstruction of either kidney. This method has been used to substitute the old, open surgery with small incisions, camera, and accuracy instruments which lead to quick healing and great long-term results.

Steps of Unilateral Laparoscopic Pyeloplasty Procedure

• Anaesthesia- The patient is put under general anaesthesia.
• Port insertion- ports are made using 3 -4 small (5-10 mm) incisions.
• Visualization - This is done by way of laparoscope, which helps in seeing the kidney and the UPJ.
• Exposure of UPJ - Surgeon mobilization of the renal pelvis and ureter.
• Excision- The constricted or blocked UPJ part is excised.
• Reconstruction (AndersonHynes dismemberment pyeloplasty is the most common)
• Renal pelvis is reshaped
• Ureter is spatulated
• UPJ is rebuilt and mended.
• Stent placement
• A Double-J stent is used to aid in healing.
• Closure- Incisions are suture and ports are removed.
• Duration: 2–3 hours
• Stent removal: 4-6 weeks in general.

Laparoscopic pyeloplasty procedure

Laparoscopic pyeloplasty is a minimally invasive procedure which is done to correct ureteropelvic junction (UPJ) obstruction. The surgeon reconstructs the place where the renal pelvis meets the ureter using small incisions, a camera, and fine dexterity instruments in order to restore normal urine flow.

Laparoscopic Pyeloplasty Procedure

Anaesthesia and Positioning of the patient

• General anaesthesia is administered on the patient.
• They are put in flank (lateral decubitus) position and expose the affected kidney.

Small Incisions (Port Placement) Creation

• Smaller incisions (5 -10 mm) are generally formed.

Ports are inserted for:

• Laparoscope (camera)
• Working instruments
• Retraction and assistance

Access and Exposure of the UPJ

• The operating surgeon cuts through fat.
• The upper ureter and renal pelvis are identified.
• Any passing ship that is obstructing is maintained.

Resection of the Obstructed UPJ Segment

• The constricted or clogged part of the UPJ is excised and resected.
• Kidney pelvis can be excised in case it is very much distended.

Reconstruction (Dismembered Pyeloplasty -AndersonHynes Technique)

• This is the commonest technique employed.
• The ureter is opened lengthwise (spatulated) to produce a wide healthy edge.
• Renal pelvis is restructured or repositioned.
• Thin absorbable sutures are used to suture the ureter to the renal pelvis.

Installation of a Double-J (DJ) Ureteral Stent

The insertion of a DJ ureteral stent across the repair is performed with the purpose of:

• Maintain adequate drainage
• Support healing
• Prevent urine leakage

Completion and Closure

• Inspection of leaks or bleeding of the surgical field.
• Ports are removed.
• The dissolvable sutures or skin glue are used in closing incisions.
• Total procedure time: ~2–3 hours

After the Procedure

• Hospital stay: 1–3 days
• Stent removal: 4-6 weeks later by cystoscopy.
• Full recovery: 3–4 weeks

Benefits of laparoscopic unilateral pyeloplasty

Unilateral laparoscopic pyeloplasty has a number of benefits over the old open procedure and thus should be used in the treatment of ureteropelvic junction (UPJ) obstruction that involves one kidney.

Minimal Invasive and Small Incisions

• Requires only 3–4 tiny cuts (5–10 mm)
• Minimal tissue damage when compared to open surgery.
• Less scarring and improved cosmetic outcome.

Less Postoperative Pain

• Less painful incisions also result in less pain.
• Reduced reliance on pain drugs.

Fast Recovery and Early Return to Activities

• Light activities are usually resumed by patients in 1-2 weeks.
• Complete recovery in 3-4 weeks.
• Less length of stay in the hospital (1-3 days).

High Success Rate

• Success rates exceed 95–98%
• Similar or more results than open pyeloplasty.
• Extremely minimal recurrence of UPJ obstruction.

Reduced Blood Loss

• Magnified view and laparoscopic instruments are useful in reducing bleeding.
• Reduced transfusion of blood.

Enhanced Vision to the Surgeon

• Closer view of the magnified picture of the kidney and UPJ.
• Helps in precise dissection
• Applicable in complicated situations involving crossing vessels.

Lower Risk of Complications

• Less risk of wound infection
• Less postoperative complications.
• Decreased hernia rates with open surgery.

Shorter Hospital Stay

• Majorities of the patients are discharged between 1 and 3 days.
• The transition to home environment is made quicker.

Improved Cosmetic Outcome

• Small and hardly noticeable scars.
• Particularly useful among young patients and children.

Suitable for All Age Groups

• Side effects are minimal with safety and efficacy in infants, children, adults, and aged patients.

Recovery after laparoscopic unilateral pyeloplasty

Laparoscopic unilateral pyeloplasty is a relatively minimally invasive procedure that is usually associated with a smooth recovery process. Early resumption of regular activities with patients is associated with rapid improvement.

Hospital Stay

• Typical hospital stay: 1–3 days
• IV fluids, pain management and antibiotics are administered.
• The patient can be able to walk a few hours after surgery.
• Oral diet is reinstated either the same day or the following day.

Pain and Discomfort

• It produces much less pain than open surgery.
• There is mild flank discomfort but this is usually short-lived.

Symptoms of the Double-J (DJ) ureteral stent include pain that can:

• Burning urination
• Frequent urination
• Mild lower abdominal pain
• The occasional flank pain when urinating.
• These symptoms are normally treated by drugs.

Stent Management

• A ureteral DJ stent is retained to aid in healing.
• It is ablated in 4-6 weeks using a brief cystoscopy.
• Consumption of much water then lessens the discomfort caused by stents.

Activity Restrictions

• Light exercise: in 1-2 weeks (or less)
• Normal routine: 2–3 weeks
• Lifting heavy, hard work: do not do during 4-6 weeks.
• Children are permitted to go back to school in a matter of few days but do not play sports.

Wound & Incision Care

• Keep incisions clean and dry
• One can shower after 24-48 hours.
• Stitches are both solvable (no removal is normally necessary)
• Pay attention to indicators of infection: erythema, swelling, pus, fever.

Diet during Recovery

• Begin with soft foods, and then go to usual food.
• Take lots of fluid (unless limited) 2-3 liters a day.
• Dehydration should be avoided because this can increase stent discomfort.

Follow-Up Tests

Doctors can recommend:

• Ultrasound after 4–8 weeks
• Renal scan (DTPA/MAG3) at 8-12 weeks.
• These make sure that there is an improvement in drainage and kidney work.

Suggested Postoperative Symptoms (Normal)

• Short time mild hematuria (blood in urine) in a few days.
• Occasional flank pain
• Industrial burning during urination.
• Fatigue for 1–2 weeks
• They are typically cured through recovery.

Factors Affecting Cost of laparoscopic unilateral pyeloplasty India

The following are the main aspects that influence the price of Laparoscopic Unilateral Pyeloplasty in India:

Selection of City / Geographic Location

• The cost in Metro cities (Delhi, Mumbai, Bengaluru, Hyderabad) is usually expensive due to the overhead, land/rent rates, and demand. 
• Less premium hospitals or smaller cities can be providing less base cost. 
• Therefore, the location of the surgery is a very significant cost determinant.

Type and Reputation of Hospital / Facility

• It is more expensive in both the case of private corporate hospitals and multi-specialty centres as well as those hospitals with advanced infrastructure.
• The fact that it is a hospital that provides international services to patients, high-quality rooms, and VIP facilities is going to add to the cost. 
• Hence, the type of hospital is important.

Experience and Expertise of a surgeon

• The higher is the experience of the surgeon (minimal invasive / laparoscopic urology in particular), the higher the price can be.
• The advanced cases that are being done by senior surgeons or the tertiary referral centres are expected to be more expensive. 

Complexity of the Case

• Such considerations as: side of obstruction (left or right), crossing vessels, previous operations, anatomical differences, either side of the kidney impaired, stone presence or infection 5 -all add complexity and hence costs.
• Preexisting conditions (diabetes, hypertension, obesity) can contribute towards risk and hospital stay potentially increasing cost. 

Length of Stay in Hospital and Room Type

• Extended stays = increased days of room rates, nursing service, meals, etc.
• A premium room (single private, deluxe) is expensive as compared to shared or basic room.

Preoperative Diagnostics and Investigations

• Essentials before surgery: imaging (USG, CT scan, renal scan), lab tests, cardiology clearance, anaesthetic work-up. More tests = higher cost.
• In the case of complications or further examination required by the patient, it becomes more expensive. 

Technique & Technology Used

• Laparoscopic vs open vs robotic: laparoscopic procedure is costlier when compared to regular open; robotic procedure is costlier when compared to laparoscopic. 
• High end laparoscopy equipment, disposable instruments that are specialized and sutures may be more expensive. 

Postoperative Care & Complications

• In case of complications (bleeding, infection, urine leak, prolonged stay) cost increases because of additional drugs, imaging, increased stay.
• Stent removal, monitoring, follow-up visits are also the added costs. Other packages can leave out additional stay or complications.

Conclusion

Laparoscopic unilateral pyeloplasty is a very effective surgical intervention which is minimally invasive and used in treating Ureteropelvic junction (UPJ) obstruction in one kidney. It has the best long term results with a success rate of more than 95 percent, less pain, less scarring and quicker healing as compared to open surgery. It has become the gold-standard method of reconstruction in adults and children due to shorter hospital admissions, accuracy in reconstruction, and lesser complication rates. Early operation, postoperative treatment and follow-ups guarantee the reestablishment of kidney drainage, eliminate the symptoms and maintain kidney functioning. All in all laparoscopic unilateral pyeloplasty is a safe, dependable and patient friendly modality of solution to UPJ obstruction.

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FAQ

1. Does laparoscopic pyeloplasty have superiority over open surgery?

• Yes. It provides smaller cuts, less pain, less blood, faster healing, and improved cosmetic outcomes and has equivalent or higher rates of success.

2. Will there be a stent placed?

• Yes. During the operation, a Double-J (DJ) ureteral stent is inserted to aid in recovery. It typically is taken out 46 weeks afterward through a brief cystoscopy procedure.

3. Is it possible to laparoscopically perform pyeloplasty in children?

• Yes. It is safe and is usually done in infants, children and adolescents with great results.

4. When will there be an improvement in the functioning of kidneys?

• Patients experience improvement within a short time of the surgery yet total recovery of kidney drainage can take a few weeks. Follow-up ultrasound/ renal scan - 8-12 weeks post stent removal.

5. Will there be a relapse of the hindrance?

• It is not common (less than 5 percent) when in the hands of laparoscopic urologic experts.

6. Is the procedure painful?

• There is minimal pain as compared to open surgery. The majority of patients are at ease with over-the-counter painkiller drugs.