Repair of Kidney Obstruction (Laparoscopic Pyeloplasty)
Indications - A kidney obstructed at the level where the kidney meets the ureter is referred to as a ureteral pelvic obstruction. (picture ) . Ureteral pelvic obstruction may be caused by several factors. The most common cause is congenital; the patient is born with the obstruction. In these patients the obstruction may not become evident until later in life. Other causes of ureteral pelvic obstruction include stone disease, infection and trauma. Once the diagnosis is made, testing must be performed to determine if the obstruction should be repaired (pyeloplasty) or the kidney should be removed (nephrectomy).
Procedure - The patient must undergo general anesthesia for this procedure. Four to five small cylindrical tubes called trocars are placed into the patients side just below the ribs. The trocars allow entry of a video-telescope, called a laparoscope, to view the entire abdominal cavity and kidney. The video-telescope gives the surgeon a magnified view of the operating field and allows identification of vessels and structures with more clarity than is possible in open surgery. Accessory small trocars allow the introduction of fine instruments necessary to perform surgery. With all the trocars and instruments in place the obstructed portion of ureter is identified and cut out. The ureter is then reattached to the kidneys' pelvis in such a way to prevent further stricture formation.
Results - Long term results of laparoscopic pyeloplasty have confirmed that complications remain low, blood loss is minimal and outcomes are excellent paralleling those performed using the standard open technique.
