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Laparoscopic pediatric pyeloplasty using the Flexdex® articulating needle driver: step-by-step video
Journal of Pediatric Urology (2019) 15, 421e422
Video Bank
Laparoscopic pediatric pyeloplasty using the Flexdex articulating needle driver: step-by-step video a Hospital de Clı´nicas de Porto Alegre, Grupo de Urologia Reconstrutiva e Infantil (GURI), Rua Ramiro Barcelos, 2350, Porto Alegre, Rio Grande do Sul, Brazil
b
Universidade Federal do Rio Grande do Sul (UFRGS), Avenida Paulo Gama, 110, Porto Alegre, Rio Grande do Sul, Brazil * Corresponding author. Grupo de Urologia Reconstrutiva e Infantil, Servic ¸o de Urologia, Hospital de Clı´nicas de Porto Alegre, Rua Ramiro Barcelos, 2350/Sala 835, Porto Alegre, Rio Grande do Sul, Brazil. [email protected] (A.R. H. Gorgen) Received 15 September 2018 Revised 25 December 2018 Accepted 26 March 2019 Available online 4 April 2019
A.R.H. Gorgen a,*, M. Araldi a, A. de Oliveira Paludo a, A.G.T. da Silva a, A.J. Ghissi a, A.S. Fernandes a, P. Tavares a, T.E. Rosito a,b, R.D. Cabral a Summary Ureteropelvic junction (UPJ) stenosis is the most common cause of pathological neonatal hydronephrosis. UPJ obstruction may be treated conservatively in some cases, but surgery is indicated if symptoms occur or renal function deteriorates. Pyeloplasty is the procedure of choice for UPJ stenosis. Pyeloplasty can be performed by open laparoscopic or robotic technique. The laparoscopic technique is safe and may be associated with shorter length of hospital stay and reduced complications. Lately, robotic pyeloplasty has been performed with
similar results, adding the benefits of easier suturing maneuverability, but with increased costs. Flexdex is a laparoscopic articulating needle driver that improves maneuverability and ergonomics. In this video, a laparoscopic pyeloplasty with the Flexdex needle drive is described. The case was treated without any intraoperative complications and with no significant blood loss, and the patient was discharged the day after the procedure. After 90 days of follow-up, there were no complications reported.
Introduction
articulating needle driver that improves maneuverability and ergonomics [5].
Ureteropelvic junction (UPJ) stenosis is the most common cause of pathological neonatal hydronephrosis. In patients screened by antenatal ultrasound, the incidence may be as high as 1 case per 500 live births. The cause of the UPJ stenosis can be intrinsic or extrinsic compression by an accessory renal artery [1]. The patient with UPJ obstruction can be asymptomatic through his or her whole life or present with recurrent flank pain and/or urinary tract infection. Although many cases can be treated conservatively, surgery is indicated if symptoms occur or renal function deteriorates. Pyeloplasty is the procedure of choice for UPJ stenosis [2]. Pyeloplasty can be performed by open, laparoscopic, or robotic technique. The laparoscopic technique is safe and feasible and may be associated with shorter length of hospital stay and reduced complications [3]. Lately, robotic pyeloplasty has been performed with similar results, adding the benefits of easier suturing maneuverability, but with increased costs [4]. Flexdex is an 8-mm laparoscopic
Material and methods A 6-year-old patient with left lumbar and flank pain diagnosed with UPJ stenosis is described. The patient underwent a DTPA scintigraphy pyelocalyceal dilatation and urinary flow obstruction. The patient underwent a laparoscopic pyeloplasty with the Flexdex needle driver. This procedure was performed on March 14, 2018, and it is the first described pediatric pyeloplasty performed using the Flexdex needle driver.
Results The operative time was 90 min. The case was treated without any intraoperative complications and with no significant blood loss, and the patient was discharged the day after the procedure. A double J stent was placed intraoperatively and removed after two weeks. After 90 days of follow-up, there were no complications reported and the patient reported no more back pain.
https://doi.org/10.1016/j.jpurol.2019.03.022 1477-5131/ª 2019 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.
422
A.R.H. Gorgen et al.
Discussion
References
This case corroborates previous publication stating the feasibility and safety of the Flexdex articulating needle drive [5]. This procedure was performed after a 2-h whitebox training without any complications. It is believed that the learning curve might be equal to or shorter than a traditional laparoscopic pyeloplasty learning curve. More studies are needed to determinate the learning curve and to compare functional outcomes.
[1] Lebowitz RL, Teele RL. Neonatal hydronephrosis: 146 cases. Urol Radiol 1983;5:185. [2] Novick AC, Streem SB. Surgery of the kidney. In: Campbell’s urology. Philadelphia: WB Saunders; 1998. [3] Huang Y, Wu Y, Shan W, Zeng L, Huang L. An updated metaanalysis of laparoscopic versus open pyeloplasty for ureteropelvic junction obstruction in children. Int J Clin Exp Med 2015;8:4922. [4] Varda BK, Wand Y, Chung BI, Lee RS, Kurtz MP, Nelson CP, et al. Has the robot caught up? National trends in utilization, perioperative outcomes, and cost for open, laparoscopic, and robotic pediatric pyeloplasty in the United States from 2003 to 2015. J Pediatr Urol 2018;14(4):336.e1e8. [5] Vigneswaran H, Crivellaro S. FlexDexTM: a novel articulated laparoscopic instrument to perform renorrhaphy. Exp Tech Urol Nephrol 2017;1(2).
Conclusions Laparoscopic pyeloplasty using Flexdex is feasible and can be easily performed with minimal additional training.
Appendix A. Supplementary data Supplementary data to this article can be found online at https://doi.org/10.1016/j.jpurol.2019.03.022.
Video Bank
Laparoscopic pediatric pyeloplasty using the Flexdex articulating needle driver: step-by-step video a Hospital de Clı´nicas de Porto Alegre, Grupo de Urologia Reconstrutiva e Infantil (GURI), Rua Ramiro Barcelos, 2350, Porto Alegre, Rio Grande do Sul, Brazil
b
Universidade Federal do Rio Grande do Sul (UFRGS), Avenida Paulo Gama, 110, Porto Alegre, Rio Grande do Sul, Brazil * Corresponding author. Grupo de Urologia Reconstrutiva e Infantil, Servic ¸o de Urologia, Hospital de Clı´nicas de Porto Alegre, Rua Ramiro Barcelos, 2350/Sala 835, Porto Alegre, Rio Grande do Sul, Brazil. [email protected] (A.R. H. Gorgen) Received 15 September 2018 Revised 25 December 2018 Accepted 26 March 2019 Available online 4 April 2019
A.R.H. Gorgen a,*, M. Araldi a, A. de Oliveira Paludo a, A.G.T. da Silva a, A.J. Ghissi a, A.S. Fernandes a, P. Tavares a, T.E. Rosito a,b, R.D. Cabral a Summary Ureteropelvic junction (UPJ) stenosis is the most common cause of pathological neonatal hydronephrosis. UPJ obstruction may be treated conservatively in some cases, but surgery is indicated if symptoms occur or renal function deteriorates. Pyeloplasty is the procedure of choice for UPJ stenosis. Pyeloplasty can be performed by open laparoscopic or robotic technique. The laparoscopic technique is safe and may be associated with shorter length of hospital stay and reduced complications. Lately, robotic pyeloplasty has been performed with
similar results, adding the benefits of easier suturing maneuverability, but with increased costs. Flexdex is a laparoscopic articulating needle driver that improves maneuverability and ergonomics. In this video, a laparoscopic pyeloplasty with the Flexdex needle drive is described. The case was treated without any intraoperative complications and with no significant blood loss, and the patient was discharged the day after the procedure. After 90 days of follow-up, there were no complications reported.
Introduction
articulating needle driver that improves maneuverability and ergonomics [5].
Ureteropelvic junction (UPJ) stenosis is the most common cause of pathological neonatal hydronephrosis. In patients screened by antenatal ultrasound, the incidence may be as high as 1 case per 500 live births. The cause of the UPJ stenosis can be intrinsic or extrinsic compression by an accessory renal artery [1]. The patient with UPJ obstruction can be asymptomatic through his or her whole life or present with recurrent flank pain and/or urinary tract infection. Although many cases can be treated conservatively, surgery is indicated if symptoms occur or renal function deteriorates. Pyeloplasty is the procedure of choice for UPJ stenosis [2]. Pyeloplasty can be performed by open, laparoscopic, or robotic technique. The laparoscopic technique is safe and feasible and may be associated with shorter length of hospital stay and reduced complications [3]. Lately, robotic pyeloplasty has been performed with similar results, adding the benefits of easier suturing maneuverability, but with increased costs [4]. Flexdex is an 8-mm laparoscopic
Material and methods A 6-year-old patient with left lumbar and flank pain diagnosed with UPJ stenosis is described. The patient underwent a DTPA scintigraphy pyelocalyceal dilatation and urinary flow obstruction. The patient underwent a laparoscopic pyeloplasty with the Flexdex needle driver. This procedure was performed on March 14, 2018, and it is the first described pediatric pyeloplasty performed using the Flexdex needle driver.
Results The operative time was 90 min. The case was treated without any intraoperative complications and with no significant blood loss, and the patient was discharged the day after the procedure. A double J stent was placed intraoperatively and removed after two weeks. After 90 days of follow-up, there were no complications reported and the patient reported no more back pain.
https://doi.org/10.1016/j.jpurol.2019.03.022 1477-5131/ª 2019 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.
422
A.R.H. Gorgen et al.
Discussion
References
This case corroborates previous publication stating the feasibility and safety of the Flexdex articulating needle drive [5]. This procedure was performed after a 2-h whitebox training without any complications. It is believed that the learning curve might be equal to or shorter than a traditional laparoscopic pyeloplasty learning curve. More studies are needed to determinate the learning curve and to compare functional outcomes.
[1] Lebowitz RL, Teele RL. Neonatal hydronephrosis: 146 cases. Urol Radiol 1983;5:185. [2] Novick AC, Streem SB. Surgery of the kidney. In: Campbell’s urology. Philadelphia: WB Saunders; 1998. [3] Huang Y, Wu Y, Shan W, Zeng L, Huang L. An updated metaanalysis of laparoscopic versus open pyeloplasty for ureteropelvic junction obstruction in children. Int J Clin Exp Med 2015;8:4922. [4] Varda BK, Wand Y, Chung BI, Lee RS, Kurtz MP, Nelson CP, et al. Has the robot caught up? National trends in utilization, perioperative outcomes, and cost for open, laparoscopic, and robotic pediatric pyeloplasty in the United States from 2003 to 2015. J Pediatr Urol 2018;14(4):336.e1e8. [5] Vigneswaran H, Crivellaro S. FlexDexTM: a novel articulated laparoscopic instrument to perform renorrhaphy. Exp Tech Urol Nephrol 2017;1(2).
Conclusions Laparoscopic pyeloplasty using Flexdex is feasible and can be easily performed with minimal additional training.
Appendix A. Supplementary data Supplementary data to this article can be found online at https://doi.org/10.1016/j.jpurol.2019.03.022.