title: Single-knot running suture anastomosis (one-knot pyeloplasty) for laparoscopic dismembered pyeloplasty: training model on a porcine bladder and clinical results.
abstract: OBJECTIVE
  The one-knot running ureteropelvic anastomosis is a modification of the single-knot running suture that was previously described for urethrovesical anastomosis. In this study, we present a novel porcine model for laparoscopic pyeloplasty training and report the results obtained in patients who underwent one-knot pyeloplasty.
  
  
  METHODS
  A porcine bladder was used for the ureteropelvic junction simulation in this training model. The laparoscopic one-knot pyeloplasty technique was attempted by five laparoscopic surgeons using this model, and the technique was then incorporated into clinical practice. The data of all patients who underwent this procedure between January 2006 and February 2008 were evaluated.
  
  
  RESULTS
  The one-knot pyeloplasty technique was easily applied in a short time by laparoscopic surgeons in a novel porcine pyeloplasty model. The participants successfully performed a watertight anastomosis in the porcine bladder model, completing the task in <30 min by the fifth attempt. The time required to succeed before and after training decreased by 20.8% (P = 0.01). In the clinical portion, 40 laparoscopic pyeloplasty procedures were performed with this technique, and the mean time to complete the anastomosis was 27.1 min (range: 12-41). This time was concordant with the final anastomosis time performed in the pelvitrainer.
  
  
  CONCLUSIONS
  The one-knot pyeloplasty is feasible and reproducible, and it overcomes the obstacles caused by multiple intracorporeal knots when performing laparoscopic pyeloplasty. Furthermore, the porcine bladder model that we introduce herein is a readily available and simple model to refine suturing techniques for pyeloplasty.
authors.affiliation: Department of Urology, SLK Klinikum Heilbronn, Am Gesundbrunnen 20, 77074 Heilbronn, Germany. jens.rassweiler@slk-kliniken.de
authors.forename: Dogu
authors.initials: D
authors.lastname: Teber
authors.forename: Selcuk
authors.initials: S
authors.lastname: Guven
authors.forename: Ozgur
authors.initials: O
authors.lastname: Yaycioglu
authors.forename: Ozgur
authors.initials: O
authors.lastname: Ugurlu
authors.forename: Oner
authors.initials: O
authors.lastname: Sanli
authors.forename: Ali Serdar
authors.initials: AS
authors.lastname: Gozen
authors.forename: Jens
authors.initials: J
authors.lastname: Rassweiler
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical; D000818:Animals; D002648:Child; D005260:Female; D006801:Humans; D007682:Kidney Pelvis / Q000601:surgery*; D010535:Laparoscopy / Q000193:education* / Q000379:methods; D059032:Learning Curve; D008297:Male; D008875:Middle Aged; D034421:Sus scrofa; D013536:Suture Techniques; D014513:Ureter / Q000601:surgery*; D001743:Urinary Bladder; D013520:Urologic Surgical Procedures / Q000193:education*; D055815:Young Adult