Indications
Laparoscopic pyeloplasty is appropriate for:
- Adults with clear UPJ obstruction who are fit for a general anaesthetic and pneumoperitoneum.
- Situations where a robotic system is not available at the preferred hospital.
- Selected patients who prefer a keyhole approach and accept the technical trade-offs compared with the robotic alternative.
How it is done
- General anaesthetic.
- Three to four small keyhole incisions are made. Carbon dioxide pneumoperitoneum creates space.
- Straight laparoscopic instruments are used to dissect the renal pelvis and ureter, move any crossing vessel, and excise the narrow segment.
- The ureter is spatulated and sewn to the renal pelvis. Because the instrument tips only open and close, the surgeon sews by rotating the whole instrument shaft - a manoeuvre that is much less precise than the robot's articulated wrist.
- A double-J ureteric stent is placed across the repair, and the ports are closed.
How it compares to robotic pyeloplasty
Kumar and Nayak (2013) directly compared robotic and conventional laparoscopic pyeloplasty in a single-surgeon cohort and found the robotic approach had a shorter operative time and a shorter hospital stay with equivalent success. Dr Kooner's own experience matches this: a robotic repair lets the surgeon make a more accurate, watertight join. For that reason, laparoscopic pyeloplasty is no longer his first choice where the robot is available.
Hospital stay and recovery
- Typical hospital stay: 2 to 3 days.
- Desk-based work usually within 2 weeks.
- Strenuous activity: 4 to 6 weeks.
- Ureteric stent removed in a day-case procedure at 4 to 6 weeks.
- MAG3 renogram at 3 to 6 months confirms drainage.
Risks and considerations
- General anaesthetic risks, port-site bleeding or infection.
- Stent-related symptoms until removal.
- Urine leak from the new join while the stent is in place.
- Narrowing of the repair over time - uncommon but possible.
- Conversion to open surgery - possible but rare.
Alternatives