title: Single-surgeon experience with transvesicoscopic ureteral reimplantation in children with vesicoureteral reflux.
abstract: OBJECTIVE
  To review our initial experience with transvesicoscopic ureteral reimplantation (TVUR) in children with vesicoureteral reflux and to evaluate the learning curve for the feasibility and reproducibility of TVUR.
  
  
  METHODS
  TVUR was performed in 28 consecutive patients with a mean age of 6.0 years. Cohen's classic technique was reproduced using a laparoscopic technique with two 3-mm working ports and a 5-mm camera port.
  
  
  RESULTS
  TVUR was successfully completed in 26 patients. In 2 patients, TVUR was converted to open intravesical reimplantation. The postoperative vesicoureteral reflux resolution rate was 94.6% (35 of 37 ureters). The mean operative time for TVUR was 166 minutes for unilateral reimplantation and 189 minutes for bilateral reimplantation. When the operation times of the first 13 and the last 13 patients were compared, the mean operative time had decreased significantly for the last 13 patients compared to that for the first 13 patients (140 vs 220 minutes). The mean postoperative hospital stay was also significantly shorter for the last 13 patients than for the first 13 patients (1.08 vs 1.69 days).
  
  
  CONCLUSIONS
  TVUR is currently performed at only at a few centers because of the technical difficulties and the potentially steep learning curve. However, our results have indicated rapid improvement in the operative time within a short period, suggesting a shorter learning curve for TVUR than expected. TVUR is a reproducible procedure and is a reasonable option for the treatment of vesicoureteral reflux.
authors.affiliation: Department of Urology and Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Chang Hee
authors.initials: CH
authors.lastname: Hong
authors.forename: Jang Hwan
authors.initials: JH
authors.lastname: Kim
authors.forename: Hyun Jin
authors.initials: HJ
authors.lastname: Jung
authors.forename: Young Jae
authors.initials: YJ
authors.lastname: Im
authors.forename: Sang Won
authors.initials: SW
authors.lastname: Han
mesh_terms: D002648:Child; D002675:Child, Preschool; D006801:Humans; D007223:Infant; D010535:Laparoscopy / Q000379:methods*; D059032:Learning Curve; D007902:Length of Stay; D010372:Pediatrics / Q000379:methods; D012092:Replantation / Q000379:methods*; D015203:Reproducibility of Results; D013514:Surgical Procedures, Operative / Q000379:methods; D013997:Time Factors; D016896:Treatment Outcome; D014513:Ureter / Q000601:surgery*; D014572:Urology / Q000379:methods*; D014718:Vesico-Ureteral Reflux / Q000601:surgery*