title: A novel set of surgical instruments facilitate the procedure of laparoscopic pyeloplasty.
abstract: BACKGROUND
  Open pyeloplasty has been historically described as the gold standard for the surgical treatment of ureteropelvic junction obstruction (UPJO), even if new techniques have recently gained a prominent role in this field. Laparoscopic pyeloplasty (LP) is not widely prevelant because of the technically challenging nature and it represents the gold standard for UPJO only in expert hands. To overcome some difficulties and technical challenges encountered during pure laparoscopic pyeloplasty, we designed a set of new instruments and assessed them using porcine model.
  
  
  METHODS
  According to the ideas from the surgeons, our medical engineer designed three new instruments, including the right angle laparoscopy scissors, the petal-shape ureter dilator and the guide tube. Four experienced laparoscopic experts were involved in a no survival porcine study to assess the help of these new instruments. Four experiments were conducted on live pigs that weighed 22 to 25 kg at the same time. After general anesthesia was administered, transperitoneal ureteroureterostomy was performed using standard laparoscopic instruments, including placing the double J stent anterograde. Then, the opposite lateral was done by the same surgeon plus these new devices for side-by-side comparative analysis. All experts were interviewed to assess these new instruments by the questionnaire based on the visual analog scale (VAS) from 1 (none) to 10 (very much).
  
  
  RESULTS
  The procedures were all technically successful. The right angle laparoscopy scissors and the guide tube were accepted by all participants and the Help Score were 6.75 and 4.25 respectively, at the same time the New Difficulty Score 1.25 and 1.75. However, the petal-shape ureter dilator got 1.5 Help Score and 6.5 New Difficulty Score. These surgeons made a negative comment and one of surgeons recommended the stone basket was more suitable.
  
  
  CONCLUSIONS
  The right angle laparoscopy scissors and the guide tube may be helpful to minimize some difficulties in pure laparoscopic pyeloplasty.
authors.affiliation: Department of Urology, General Hospital of Chinese People's Liberation Army, Beijing 100853, China.
authors.forename: Wen-Zheng
authors.initials: WZ
authors.lastname: Chen
authors.forename: Fei
authors.initials: F
authors.lastname: Guo
authors.forename: Yun
authors.initials: Y
authors.lastname: Li
authors.forename: Riccardo
authors.initials: R
authors.lastname: Autorino
authors.forename: Jin-Yi
authors.initials: JY
authors.lastname: Li
authors.forename: Hui-Qing
authors.initials: HQ
authors.lastname: Wang
authors.forename: Fatih
authors.initials: F
authors.lastname: Altunrende
authors.forename: Ying-Hao
authors.initials: YH
authors.lastname: Sun
mesh_terms: D000818:Animals; D007682:Kidney Pelvis / Q000601:surgery*; D010535:Laparoscopy / Q000295:instrumentation* / Q000379:methods; D015607:Stents; D013552:Swine