Transmesocolic approach for left side laparoscopic pyeloplasty : comparison to laterocolic approach in the initial learning period

Abstract

Objective: To evaluate the outcome of transmesocolic laparoscopic pyeloplasty compared to the conventional laterocolic procedure for surgeons with limited experience. Methods: We adopted laparoscopic pyeloplasty for ureteropelvic junction obstruction in 2009. Since then, 21 patients of left side disease have undergone this surgery in our institution. To access the left ureteropelvic junction, we used the conventional laterocolic approach in 9 patients, while the transmesocolic approach was used in the remaining 12 patients. Subsequently, perioperative results and follow-up data were compared.Results: The mean operative time using the transmesocolic approach was significantly shorter than using the conventional laterocolic approach (242 vs. 308 min, p = 0.022). There was no complication or open conversion. Postoperative pain was significantly decreased in the TMC group (2.8 vs. 4.0 points, measured using the visual analogue scale on the first postoperative day, p = 0.009). Postoperative complications were encountered in two patients. All patients were symptom-free after 1 year of follow-up, and radiologic success rates for each group were 92 and 89% respectively.Conclusions: The direct exposure of the ureteropelvic junction via the mesocolon saves time during the colon mobilization procedure. The approach is safe and feasible even for beginning surgeons, with similar success rates compared to the conventional laterocolic approach.