title: Scarless pyeloplasty in the pediatric population.
abstract: OBJECTIVE
  To assess the outcomes of a modified technique for pediatric laparoscopic pyeloplasty (LP) performed without instrument trocars.
  
  
  METHODS
  A retrospective cohort study for all LPs performed without instrument trocars was performed. Patient demographics, surgical technique, complications, and clinical outcomes were reviewed. All patients undergoing this procedure had a single trocar placed to insufflate and introduce the laparoscope. Skin punctures were used without trocars to introduce 3-mm instrumentation for LP.
  
  
  RESULTS
  Nine patients with 10 procedures were identified. Median age was 8 months old (range 3-190). Median weight was 8.3 kg (range 5.9-70.5). Median operative time was 229 minutes (range 145-387). All procedures were performed without additional trocars. There were no open conversions. Median hospital stay was 1 day (range 1-4). Median narcotic use was 0.1 mg/kg/d of intravenous morphine equivalent. There were no intraoperative complications. Median follow-up was 36 months (range 18-45). Follow-up renal ultrasound evaluation has demonstrated improved hydronephrosis in all patients. No reoperative pyeloplasty was performed. Subjective assessment of cosmesis has shown excellent outcome with almost imperceptible evidence of operative intervention.
  
  
  CONCLUSIONS
  LP without instrument trocars can be safely and effectively performed without compromise of the surgical procedure, with minimal use of narcotics, and with a short hospital stay. Intermediate-term follow-up indicates encouraging results for achieving scarless surgery.
authors.affiliation: Division of Pediatric Urology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229-3039, USA. paul.noh@cchmc.org
authors.forename: Paul H
authors.initials: PH
authors.lastname: Noh
authors.forename: Goutham
authors.initials: G
authors.lastname: Vemana
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D002921:Cicatrix / Q000517:prevention & control*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007223:Infant; D007682:Kidney Pelvis / Q000601:surgery*; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D012189:Retrospective Studies; D014517:Ureteral Obstruction / Q000601:surgery*; D013520:Urologic Surgical Procedures / Q000379:methods