opn pyeloplast.pptx

advantages of open pyeloplasty over laparoscopy

1. OPEN vs LAPAROSCOPIC pyeloplasty Ahmed M Eliwa MD UROLOGY AND ANROLOGY

2. Symptomatic obstruction (recurrent flank pain, UTI) requires surgical correction using a pyeloplasty, according to the standardised open technique of Hynes and Anderson [ 492 ] There does not seem to be any clear benefit of minimal invasive procedures in a very young child but current data is insufficient to defer a cut-off age

3. Why is open pyeloplasty is the gold standard for treatment of PUJO? Why is laparoscopy is not??

4. Indications Technical aspects Outcomes and Cost

5. Open pyeloplasty is the standard surgical TTT for the PUJO Universal treatment for universal pathology Indications Training Outcomes and Cost

6. LP Technically challenging patients [morbidly obese , children less than 1year] failed open pyeloplasty [ perinephric scarring and the potential for devascularization of the proximal ureter] Indications Training Outcomes and Cost

7. small intrarenal pelvis Long stricture in the upper ureter Indications Training Outcomes and Cost

8. Technical aspects

9. Incision Magnification Traction sutures Prestenting The surgical procedure and judgment on renal parenchyma or pelvic dimension Excellent assessment of secondary pathologies Training and learning curve Indications Technical Outcomes and Cost

10. OPEN PYELOPLASTY Incision in open pyeloplasty is not long Indications Technical Outcomes and Cost

11. Indications Technical Outcomes and Cost

12. Indications Technical Outcomes and Cost

13. Indications Technical Outcomes and Cost A muscle-splitting dissection was done to reach the Gerota’s fascia and expose the UPJ,

14. Traction sutures and orientation Traction sutures are crucial part of pyeloplasty In open pyeloplasty they are easily done Orientation and good judgment on the dimension Indications Technical Outcomes and Cost

15. Magnification Indications Technical Outcomes and Cost

16. Prestenting Technical highlights include initial placement of an internal ureteral stent Laparoscopic dismembered pyeloplasty. Schuessler WW , Grune MT , Tecuanhuey LV , Preminger GM The Journal of Urology [1993, 150(6):1795-1799] Indications Technical Outcomes and Cost

17. Indications Technical Outcomes and Cost previous ureteral stenting subjectively complicated the surgical dissection.

18. Indications Technical Outcomes and Cost Yurkanin JP, Fuchs GJ (2004) Laparoscopic dismembered pyeloureteroplasty : a single institution’s 3-year experience. J ndourol 18: 765–769. Siqueira TM, Jr., Nadu A, Kuo RL, Paterson RF, Lingeman JE, et al. ( 2002) Laparoscopic treatment for ureteropelvic junction obstruction. Urology 60: 973–978. Moon DA, El- Shazly MA, Chang CM, Gianduzzo TR, Eden CG ( 2006) Laparoscopic pyeloplasty: evolution of a new gold tandard . Urology 67: 932–936 . Dissection and full mobilization difficult owing to the decompression of the renal pelvis by the stent. The stent can be cut accidentally [migration]  

19. impede the identification of the extent of the stenosis and hinder trimming of the ureter and suturing of the posterior anastomosis Gaitonde K, Roesel G, Donovan J (2008) Novel technique of retrograde ureteral stenting during laparoscopic pyeloplasty. JEndourol 22: 1199–1202 Arumainayagam N, Minervini A, Davenport K, Kumar V, Masieri L, et al . ( 2008) antegrade versus retrograde stenting in laparoscopic pyeloplasty. J Endourol 22: 671–674. Indications Technical Outcomes and Cost

20. Procedure In OP a plethora of procedures are available for the surgeon to deal with UPJO however A-H dismembered pyeloplasty is the most commonly practiced procedure for repair Indications Technical Outcomes and Cost

21. Suturing In open pyeloplasty is very easy Indications Technical Outcomes and Cost

22. Indications Technical Outcomes and Cost laparoscopic suturing Laparoscopic suturing is a difficult skill to master but can be acquired with extensive training outside the operating room

23. Indications Technical Outcomes and Cost Robotics eliminated the early learning curve for novices, which was present when they used standard laparoscopic tools

24. Simulators Indications Technical Outcomes and Cost

25. Indications Technical Outcomes and Cost The  EndoStich  gives the surgeon the advantage of being able to easily pass sutures

26. Training and learning curve Indications Technical Outcomes and Cost

27. Lets make it more difficult

28. Retro

29. Single port

30. Outcomes, complications and costs

31. OR time LOS COSTS Complications Indications Technical Outcomes and Cost

32. Indications Technical Outcomes and Cost

33. Retroperitoneal Laparoscopic Pyeloplasty Series Indications Technical Outcomes and Cost

34. Indications Technical Outcomes and Cost Hong Mei, Jiarui Pu , Chunlei Yang, Huanyu Zhang, Liduan Zheng , and Qiangsong Tong . Journal of Endourology. May 2011, 25(5): 727-736. doi:10.1089/end.2010.0544. Published in  Volume: 25 Issue 5: May 25, 2011 October 2010 were searched from Medline, Embase , Web of Science, Ovid, and Cochrane databases. Laparoscopic Versus Open Pyeloplasty for Ureteropelvic Junction Obstruction in Children: A Systematic Review and Meta-Analysis

35. Of 1403 studies, one randomized controlled trial (RCT ) two prospective comparative studies, six retrospective observational studies were eligible for inclusion criteria, comprising 694 cases of LP and 7334 cases of OP. Indications Technical Outcomes and Cost

36. The OP has significantly reduced operative time P <0.00001 Higher stent placement rate P <0.00001 Indications Technical Outcomes and Cost Because of the publishing bias, a series of RCTs are necessary to explore the efficiencies of LP in the management of UPJ obstruction in children.

37. Indications Technical Outcomes and Cost Laparoscopic vs Open Pyeloplasty in Children: Results of a Randomized, Prospective, Controlled Trial. Gatti JM1, Amstutz SP2, Bowlin PR1, Stephany HA3, Murphy JP1. J Urol. 2016 Oct 17. pii : S0022-5347(16)31528-2. doi : 10.1016/j.juro.2016.10.056 -mean operative time , which was 139.5 minutes (range 94 to 213) in the laparoscopic group and 122.5 minutes (83 to 239) in the open group (p <0.01 ) - mean length of stay, which was 25.9 hours (18 to 143) in the laparoscopic group and 28.2 hours (16 to 73) in the open group (p = 0.02). the clinical significance of these variables is questionable. The approach to repair may best be based on family preference for incision aesthetics and surgeon comfort with either approach, rather than more classically objective outcome measures

38. Complications TRANSPERITONEAL Indications Technical Outcomes and Cost

39. Indications Technical Outcomes and Cost

40. Indications Technical Outcomes and Cost

41. Indications Technical Outcomes and Cost National Trends of Perioperative Outcomes and Costs for Open, Laparoscopic and Robotic Pediatric Pyeloplasty Briony K. Varda  Emilie K. Johnson , Curtis Clark , Benjamin I. Chung , Caleb P. Nelson , Steven L. Chang JOURNAL OF UROLOGY .  2014 Apr;191(4): 1090-5 . Operative time was longer for minimally invasive  pyeloplasty compared to open pyeloplasty Laparoscopic and robotic pyeloplasty had longer median operative times (240 minutes, p <0.0001 and 270 minutes, p <0.0001, respectively ]. Length of stay was equivalent across all procedures.

42. Indications Technical Outcomes and Cost

43. Korede Bello

44. One-trocar-assisted pyeloplasty: An attractive alternative to open pyeloplasty.  African Journal of Paediatric Surgery: Marte A, Papparella A . AJPS . 2015;12(4):266-269. doi:10.4103/0189-6725.172569. November 2010Volume 184, Issue 5, Pages 2109–2115 One-Port Retroperitoneoscopic Assisted Pyeloplasty Versus Open dismembered Pyeloplasty in Young Children: Preliminary Experience . Paolo Caione , Alberto Lais , Simona Ger