Laparoscopic Pyeloplasty

Reconstructive surgery can be carried out safely and effectively for patients with laparoscopic pyeloplasty. shrinkage or scarring where the ureter links the kidney with a minimally invasive treatment (the ureter is the tube that empties the kidney to the bladder). It is applied to fix ureter obstructions or narrowing that develop as the ureter exits the kidney. This anomaly, known as a hitch of the ureteropelvic junction (UPJ), causes a weak and sluggish urine flow from the kidneys. A UPJ obstruction may result in flank and abdominal pain, kidney dysfunction, infections, high blood pressure, and renal stones. Laparoscopic pyeloplasty has many advantages over open surgery, including much less postoperative pain, a shorter hospital stay, quicker return to work and normal activities, and cosmetic results that are just as good.

What is Laparoscopic Pyeloplasty?

Through a minimally invasive operation called laparoscopic pyeloplasty, an obstruction or scarring where the ureter (the tube that transports urine from the kidney to the bladder) joins to the kidney can be repaired surgically.

This procedure is intended to fix a narrowing or obstruction of the ureter where it exits the kidney. This condition, known as a ureteropelvic junction (UPJ) obstruction, causes slow and inefficient kidney urine outflow. Abdominal and flank pain, kidney problems, infection, elevated blood pressure, and stones are all possible effects of UPJ obstruction.

Laparoscopic pyeloplasty provides much less post-operative discomfort than the traditional open surgical approach, a shorter hospital stay, a faster return to work and everyday activities, a more pleasing cosmetic outcome, and outcomes that are identical to those of the open operation.

Laparoscopic Pyeloplasty Advantages

In comparison to open surgery, laparoscopic surgery for the treatment of symptomatic UPJ obstruction offers considerable advantages to the patient in terms of decreased blood loss and transfusions, decreased pain, shorter hospital stays, enhanced cosmoses, and quicker recovery. As a result, it is now widely accepted for the surgical treatment of UPJ obstruction. Regarding the relief of blockage and symptoms, published results of laparoscopic pyeloplasty seem equivalent to those of open pyeloplasty.

Laparoscopic Pyeloplasty Indications

Pyeloplasty is only recommended for those who have been given a UPJ obstruction diagnosis. Even while the disorder can affect people of any age, it is most frequently found in young children and even unborn babies. This is because hydronephrosis can be discovered as early as the first trimester during a maternal ultrasound. This implies that the procedure can be prepared for and carried out even before the baby is born.

The obstruction may have a variety of causes, such as the development of polyps or tumors, an incorrectly positioned blood vessel, the formation of scar tissue, or kidney stones. For those who are still in utero, the issue often arises as a result of defects in the development of the fetus, such as when the tubes gradually narrow and develop strictures (constrictions).

The obstruction may be difficult to identify unless the issue has been identified by an ultrasound because the infant may be asymptomatic for some time. Long-term effects could include recurrent urinary tract infections (UTIs), blood while urinating, and soreness in the lower back where the kidneys are located.

Who are not Good Candidate For Laparoscopic Pyeloplasty

Patients who have undergone several, major abdominal procedures in the past, particularly kidney surgery, may have substantial scarring around the kidney and renal pelvis and are therefore not the best candidates for a laparoscopic approach. Such circumstances can call for open surgery. Due to the need for general anesthesia, patients with health conditions such as severe heart and lung problems may not be able to tolerate a laparoscopic procedure.

Laparoscopic Pyeloplasty Preparation

Just like you were instructed, get ready for the procedure. In addition:

Inform your healthcare practitioner of any medication you use. This includes vitamins, herbals, and supplements in addition to prescription and over-the-counter medications. According to your doctor's instructions, you might need to stop taking any or all of them before surgery.

Avoid eating or drinking for eight hours before surgery. Water, gum, and mints are included in this.

The day before the procedure, you might be prescribed a specific liquid or drug to take. This will ensure that your colon is empty before the procedure.

How Does Laparoscopic Pyeloplasty Work?

Fiber-optic tools are used in laparoscopic pyeloplasty to remove the obstruction. A laparoscopy also referred to as keyhole surgery, is a far less invasive treatment that greatly minimizes the hazards of open surgery.

Using fiber-optic technology, surgeons may now repair organs, identify joint disorders, and remove unhealthy tissues with increasing frequency.

Because only very small incisions are made during the process thanks to fiber-optic technology, it is a low-risk, minimally invasive surgery with a substantially shorter recovery period. Robotics can potentially be used to perform the surgery.

Laparoscopic Pyeloplasty Procedure

Under general anesthesia, pyeloplasty is performed laparoscopically. The average work lasts three to four hours. Three little (1 cm) abdominal incisions are made surgically. The surgeon can fix the obstruction or stenosis without having to touch the stomach thanks to small incisions that allow the telescope and other devices to be placed into the abdomen.

After the laparoscopic pyeloplasty surgery, a little plastic tube known as a ureteral stent is left in the urethra to help in kidney drainage. After four weeks, this stent is often removed at the physician's office. His side was also allowed to drain a small amount of fluid for pyeloplasty and kidney repair.

Robotic Laparoscopic Pyeloplasty

In robotic pyeloplasty, which is very similar to laparoscopic surgery, the surgical tools are attached to a robotic system that is operated by the surgeon via a computer interface rather than the surgeon using their own hands. The robotic system's precision improves the surgeon's movements' accuracy, control, and flexibility. Less bleeding, smaller scars, less discomfort, and faster recovery are all benefits of robotic surgery. The risk of infection is also decreased.

Laparoscopic Pyeloplasty Recovery

Once completely awake and your vital signs are stable following the surgery, the patient will be brought to the recovery room and then to his hospital room.

• Hospital stays.  Most people stay in the hospital for roughly 1-2 days.
• Diet. The majority of patients can tolerate ice chips and little amounts of liquid the day after surgery, following the next day by regular diet. Painkillers may be taken orally after returning to the regular diet but not via injection or intravenously.
• Pain following surgery. A nurse can administer an intravenous (pain injection) or patient-controlled analgesia (PCA) pump to the patient to administer pain medication. In comparison to the carbon dioxide gas used to inflate the belly during laparoscopic surgery, you might experience mild, temporary shoulder pain that lasts for 1-2 days. Nausea may be brought on by painkillers used during anesthesia. There are medications for persistent nausea.
• Urinary Catheter. For around two days following surgery, you can anticipate using a urinary catheter to evacuate the patient's bladder. After surgery, it is usual to experience blood-tinged urine for a few days.
• Drain. A little incision in your side will be used to drain you. To avoid bleeding, the buildup of fluid around the kidney, and Pyeloplasty repair, this drain is inserted on the surgical site around the operating space. Usually, the drainage has a bloody tint to it. It is often taken out on the same day as the urinary catheter. You can take the drain home with you and get it removed in your physician's office if the excess flow doesn't stop. After surgery, fatigue is typical and should go away in a few weeks.
• Incentive spirometry. Using an incentive spirometry device, you will be asked to do some basic breathing exercises to aid in the prevention of respiratory infections (such exercises will be discussed with you during your hospital stay). Deep breathing and coughing are essential components of the healing process because they help prevent pneumonia and other lung problems.
• Ambulation. To prevent blood clots from developing in your legs the day following surgery, it is necessary to get out of bed and begin walking under the watch of a caregiver or family member. To keep blood clots from forming in your legs, expect to wear sequential compression devices with low white tightness.
• Constipation or gastric cramps. The anesthesia used during surgery may cause sluggish bowel movements for a few days after the procedure. To alleviate this issue, suppositories and stool softeners are frequently administered. Additionally, taking a teaspoon of mineral oil daily at home can help you avoid constipation. Patients are advised to stop using any narcotic painkillers following surgery because they can also lead to constipation.

After Returning Home

It is very common for the patient to have discomfort for a day or two following the procedure. If you take paracetamol every four to six hours for the next day or two, it should usually be enough to get rid of any pain.

Before you go home, we will give you some stronger medication if the patient requires it. You should call your doctor if you believe your child requires more painkillers when you return home.

You are advised to drink a lot of fluids to flush the kidneys in the days following surgery. After the procedure, the patient shouldn't take a bath or a shower for two days. The patient is free to take a shower after this, but try to avoid taking a long bath because it could cause the scab to weaken and fall off too soon.

Steri-strips will be used to close the procedure site. The Steri-strips typically come off on their own within a week, but if not, you can rinse them with a moist flannel.

Laparoscopic Pyeloplasty Complications

Even though this operation has a very high safety record, there are still potential risks and problems. Safety speed and comparable complications to open surgery. Risks that may arise include:

• Bleeding. Less than 100 ml of blood is often lost during this treatment, which infrequently necessitates blood transfusions. Your surgeon should be informed if you are still considering receiving an autologous blood transfusion (donating blood) before surgery.
• Infection. Before surgery, broad-spectrum antibiotics are administered intravenously to the majority of patients to treat their conditions and lower their risk of infection. Contact your physician immediately if you experience any signs or symptoms of infection following surgery (such as high temperature, discharge from the incision, frequent urinary discomfort, pain, or any cause for concern).
• Hernia. Hernias at the incision sites are extremely uncommon because all incisions close and lock at the end of surgery.
• Organ or tissue injury. Even though it happens seldom, surgery to replace the surrounding tissues or organs may be necessary for injuries to the gut, vascular structures, spleen, liver, pancreas, and gall bladder. The injury could occur to the muscles or nerves involved in positioning.
• Conversion to open surgery.  If considerable difficulties are experienced during the laparoscopic procedure, surgical processes may need to be converted to standard open surgery. This may result in a greater conventional open-cut recovery lasting longer. 
• Failure of UPJ obstruction correction. About 3% of patients who undergo this surgery will experience a long-lasting obstruction because of recurrent healing. If this occurs, further surgery might be needed.

Laparoscopic Pyeloplasty Outcomes

The retroperitoneal laparoscopic approach is effective for performing laparoscopic pyeloplasty. The surgical results are comparable to previously published laparoscopic pyeloplasty series in adults performed with a laparoscopic transperitoneal approach with outstanding clinical and radiologic success rates.

Ten adult patients with unilateral ureteropelvic junction (UPJ) obstruction received laparoscopic pyeloplasty in just one year, from February 2004 to March 2005. After a failed endopyelotomy, UPJ blockage was primary in six patients and secondary in four patients. With the help of a retroperitoneal method (developed by balloon dissection), laparoscopic pyeloplasty was performed. The robot was given three retroperitoneal laparoscopic ports, while the assistant made use of a fourth port. The entire treatment was carried out using a robotically assisted laparoscopic approach. The robot was successfully used to complete all cases (seven right and three left) without switching to a standard open method.

Conclusion

A pyeloplasty is a technique used to treat an obstruction at the ureteropelvic junction. The danger of this surgery is relatively minimal. You won't most likely encounter this issue once this has been done. If you're thinking about having this treatment, call your doctor to arrange for a consultation. The advantages and disadvantages of this surgery can be discussed with your doctor.