title: Microlaparoscopy versus conventional laparoscopy in transperitoneal pyeloplasty.
abstract: OBJECTIVE
  Laparoscopic pyeloplasty has emerged as the gold standard for repair of ureteropelvic junction obstruction. Microlaparoscopic (MLP, <3 mm) instrumentation has improved markedly and can now be used for suturing and complex dissection needed during laparoscopic pyeloplasty. We present our experience with microlaparoscopy compared with conventional laparoscopy for transperitoneal pyeloplasty.
  
  
  METHODS
  We performed a retrospective analysis of hybrid MLP, using a 5-mm camera in a hidden umbilical incision, and 1.9 or 3 mm working instruments and compared with patients undergoing conventional laparoscopic pyeloplasty (CLP). The data for MLP and CLP were compared using the Student t test, Pearson chi-square test, and Fisher exact test, where appropriate.
  
  
  RESULTS
  Between January 2009 and May 2013, there were 19 MLP and 27 CLP procedures performed. The MLP group mean age was younger than the CLP group (34 vs 50 years; P=0.0003). Body mass index, previous treatment rates, operative time, length of stay, ureteral stent duration, and complication rates were not statistically different between the MLP and CLP groups. Strict success rates (indicated by follow-up renal scan T½<20 min) were similar between MLP and CLP groups (89.5% vs 88.9%; P=0.95). No MLP procedures were converted to CLP or open approaches.
  
  
  CONCLUSIONS
  From technical, perioperative, and outcome perspectives, transperitoneal pyeloplasty with microlaparoscopy is both safe and feasible in our hands compared with conventional laparoscopy, and results in subjectively superior cosmesis. This is the largest MLP series to date and contains, to our knowledge, the only cases described using prototype 1.9 mm instruments.
authors.affiliation: Department of Urologic Surgery, Vanderbilt University Medical Center , Nashville, Tennessee.
authors.forename: Aaron D
authors.initials: AD
authors.lastname: Benson
authors.forename: Trisha M
authors.initials: TM
authors.lastname: Juliano
authors.forename: Davis P
authors.initials: DP
authors.lastname: Viprakasit
authors.forename: S Duke
authors.initials: SD
authors.lastname: Herrell
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D007668:Kidney / Q000601:surgery; D007682:Kidney Pelvis / Q000601:surgery*; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D011183:Postoperative Complications; D019651:Plastic Surgery Procedures; D012189:Retrospective Studies; D015607:Stents; D016896:Treatment Outcome; D014513:Ureter / Q000601:surgery*; D014517:Ureteral Obstruction / Q000601:surgery*; D013520:Urologic Surgical Procedures / Q000379:methods*