Bilateral simultaneous laproendoscopic single site surgery (LESS) pyeloplasty in a 4 month old child (SIU 2011)
- uploaded: Sep 18, 2011
- Views: 665
Institution:Muljibhai Patel Urological Hospital, Nadiad, India
Reports regarding LESS in infants are scant. Reconstructive procedures in these small patients are accompanied with difficulties in suturing and need for smaller instruments. In this video we demonstrate a case of simultaneous bilateral LESS pyeloplasty in a 4 month old child.
Material and methods
The 4 month old infant presented with antenatal detected bilateral hydronephrosis with proven obstruction on diuretic renogram. The patient was planned for simultaneous LESS pyeloplasty. Standard laparoscopic instruments were used with the R-port TM as the access port. The Olympus endoeye TM camera was used for the purpose. An Antegrade ureteric splint was placed preoperatively .
An Antegrade ureteric splint was placed prior to pyeloplasty An ultrasound guided percutaneous renal access was obtained. Telescopic metal two part needle was passed into the kidney over a guide wire. A second guide wire is passed through the Telescopic metal two part needle. The tract is dilated with 14 Fr screw dilator. Over one guide wire, a 5 Fr ureteric catheter is passed and coiled in the renal pelvis. Over the other wire, a 14 Fr Malecot catheter is placed as Nephrostsomy.
The same procedure was repeated on the other side. A R-port was inserted through a umbilical skin crease incision. The right side was done first. The Ureteropelvic junction was dissected. A Anderson Hynes pyeloplasty was performed with reduction. The ureteric catheter placed prior was not in proper position on the right side hence an intraoperative DJ was placed. On the left side a similar procedure was repeated. The ureteric catheter placed Antegrade preoperatively was passed into the ureter after the posterior wall suturing was completed.
This video demonstrates the feasibility of LESS in children as young as 4 months of age. The video also demonstrates that Ultrasound guided ante grade nephroureteral ureteral splint for infant laparoscopic pyeloplasty is safe. It avoids the need for urethral instrumentation for insertion and removal of stents in these small patients
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