CU 50. Laparoscopic pyeloplasty: A comparison between the transperitoneal and the retroperitoneal approach during the learning curve

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.