title: Lessons from 90 consecutive laparoscopic dismembered pyeloplasties in a residency program.
abstract: OBJECTIVE
  The aim of this study was to report on the safety and efficacy of 90 consecutive laparoscopic pyeloplasties carried out in a university hospital.
  
  
  METHODS
  The outcomes of 90 transperitoneal dismembered pyeloplasties that were performed by residents at the hospital from March 2004 to March 2010 were analyzed. All of the surgeries were performed because of symptomatic ureteropelvic junction obstruction. The laparoscopic Anderson-Hynes dismembered technique was used in all cases, and a double-J stent was routinely placed and left in place for 4 weeks. The patients were followed up clinically and with imaging studies. Clinical data, outcomes and complication rates for the patients were retrospectively reviewed using a prospectively maintained database.
  
  
  RESULTS
  The mean patient age was 38.9 (10-80) years, and 46 patients (51.1%) were males. The mean operative time was 222.5 (125-400) min. The surgery was completed laparoscopically in 96.6% of cases (87 patients). Conversion was required owing to technical difficulties in three cases. Overall, four (4.4%) patients had major complications. Seventy-six of the 87 patients (87.3%) presented improvements in symptomatology at a median follow-up of 39.7 (6-75) months.
  
  
  CONCLUSIONS
  Laparoscopic pyeloplasty is feasible and associated with high success and low complication rates, even in a residency program.
authors.affiliation: Division of Urology, Department of Surgery, Hospital das Clínicas, University of São Paulo Medical School, São Paulo, Brazil. marcoarap@hotmail.com
authors.forename: Marco Antonio
authors.initials: MA
authors.lastname: Arap
authors.forename: Fabio Cesar Miranda
authors.initials: FC
authors.lastname: Torricelli
authors.forename: Anuar Ibrahim
authors.initials: AI
authors.lastname: Mitre
authors.forename: Jose Luis
authors.initials: JL
authors.lastname: Chambo
authors.forename: Ricardo Jordão
authors.initials: RJ
authors.lastname: Duarte
authors.forename: Miguel
authors.initials: M
authors.lastname: Srougi
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006785:Hospitals, University; D006801:Humans; D007396:Internship and Residency; D010535:Laparoscopy / Q000379:methods*; D059032:Learning Curve; D008297:Male; D008875:Middle Aged; D061214:Patient Safety; D011361:Professional Competence; D012189:Retrospective Studies; D016896:Treatment Outcome; D014517:Ureteral Obstruction / Q000601:surgery*; D013520:Urologic Surgical Procedures / Q000379:methods*; D055815:Young Adult