Purpose: To compare the transperitoneal approach and the
retroperitoneal approach in the laparoscopic management of
pelvi-ureteric junction obstruction (PUJO), at two different
urologic centers during the learning curve period.
Materials and Methods: We prospectively evaluated 50
consecutive laparoscopic pyeloplasty performed by two
different urologists during their learning cur ve period
in laparoscopy. Each surgeon used a different approach:
Transperitoneal (group A) and retroperitoneal (group B).
Timing for patient positioning, trocar placement and access
to the operating field, ureter and pelvi-ureteric junction
isolation, pelvi-ureteric junction suturing were recorded to
compare the transperitoneal with the retroperitoneal method.
Intraoperative complications and perioperative morbidity
were also reported.
Results: Twenty-two procedures were performed using
the transperitoneal method (group A) and twenty-eight
using the retroperitoneal method (group B). Significant
differences between group A and B were observed in terms
of time for access to the operating field (mean times 25 and
15 min, respectively, P<0.05); time for suturing the pelviureteric
junction (mean times 57 and 103 min, respectively,
P<0.001); and total operative time (mean times 127 and 201
min, respectively, P<0.002). No statistical differences were
observed for any other parameters. Blood loss was minimal in
all cases (mean losses 85 and 90 mL, respectively, P=0.834);
and hemotransfusion was not needed by either group. Average
follow-up was 10 and 11 months for groups A and B, no
statistical differences were observed.
Conclusions: We suggest that urologists in training for
laparoscopy perform laparoscopic pyeloplasty using a
transperitoneal route. In expert hands, both transperitoneal and
retroperitoneal approaches are feasible, and the choice depends
on personal preference.