Laparoscopic pyeloplasty: an analysis of first 100 cases and important lessons learned

Laparoscopic pyeloplasty (LP) is a minimally invasive approach that is becoming a standard treatment of ureteropelvic junction obstruction (UPJO). It is providing similar results when compared with open surgery. We here present our technique and analyses of experience of our first 100 cases. We retrospectively reviewed and analyzed the records of first 100 cases of LP performed for UPJO with dilatation of renal pelvis at our centre. Patients' profile; perioperative, intraoperative and postoperative parameters like time of surgery, blood loss, complications, duration of hospital stay, outcome of procedure were analyzed. The mean operative time, need for an extra-port, conversions to open, estimated blood loss, complications and recurrences all significantly decreased after first 50 cases. One patient developed shock due to bleeding from inferior epigastric vessels near port-site, and had to be explored. Overall success rate was 96%. Lesser incidence of fourth-port insertion, conversions to open, and thus decreased operative time was attributed to introduction of additional techniques to reduce the learning curve. LP is a technically difficult procedure. Sticking to the basic steps of LP, and trying and thus incorporating additional tactics are useful to reduce the learning curve.