title: Transmesocolic approach for left side laparoscopic pyeloplasty: comparison with laterocolic approach in the initial learning period.
abstract: OBJECTIVE
  To evaluate the outcome of transmesocolic (TMC) laparoscopic pyeloplasty compared with conventional laterocolic procedure for surgeons with limited experience.
  
  
  METHODS
  We started laparoscopic pyeloplasty for ureteropelvic junction obstruction in 2009. Since then, 21 patients of left side disease have undergone this surgery in our institution. To access the left ureteropelvic junction, we used the conventional laterocolic approach in 9 patients, while the transmesocolic approach was used in the remaining 12 patients, and perioperative results and follow-up data were then compared.
  
  
  RESULTS
  The mean operative time using the transmesocolic approach was significantly shorter than the conventional laterocolic approach (242 vs. 308 min, p=0.022). Furthermore, there was no complication or open conversion. Postoperative pain was significantly decreased in the TMC group (2.8 vs. 4.0 points, measured using the visual analogue scale on the first postoperative day, p=0.009). Postoperative complications were encountered in two patients. All patients were symptom-free after 1 year of follow-up, and radiologic success rates for each group were 92 and 89%, respectively.
  
  
  CONCLUSIONS
  Direct exposure of the ureteropelvic junction via the mesocolon saves time during the colon mobilization procedure. The approach is safe and feasible even for surgeons with limited experience, and has success rates similar to those of the conventional laterocolic approach.
authors.affiliation: Department of Urology, Yonsei University College of Medicine, Gangnam Severance Hospital, Seoul, Korea.
authors.forename: Hyun Ho
authors.initials: HH
authors.lastname: Han
authors.forename: Won Sik
authors.initials: WS
authors.lastname: Ham
authors.forename: Jang Hwan
authors.initials: JH
authors.lastname: Kim
authors.forename: Chang Hee
authors.initials: CH
authors.lastname: Hong
authors.forename: Young Deuk
authors.initials: YD
authors.lastname: Choi
authors.forename: Sang Won
authors.initials: SW
authors.lastname: Han
authors.forename: Byung Ha
authors.initials: BH
authors.lastname: Chung
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D003106:Colon / Q000601:surgery; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D007223:Infant; D007668:Kidney / Q000601:surgery*; D007682:Kidney Pelvis / Q000601:surgery*; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D010149:Postoperative Pain; D011184:Postoperative Period; D019651:Plastic Surgery Procedures / Q000379:methods; D013997:Time Factors; D014513:Ureter / Q000601:surgery; D014517:Ureteral Obstruction / Q000601:surgery; D013520:Urologic Surgical Procedures / Q000379:methods*; D055815:Young Adult