title: A modified technique of paraumbilical three-port laparoscopic dismembered pyeloplasty for infants and children.
abstract: BACKGROUND
  Common causes of complications of laparoscopic pyeloplasty in children include anastomotic stricture, poor drainage due to high ureteropelvic anastomosis, and torsion of ureter. Herewith, we described our modified technique of paraumbilical three-port laparoscopic dismembered pyeloplasty (PTLDP) to minimize these complications.
  
  
  METHODS
  Data from 62 patients (age: 1-180 months, median: 12 months) with ureteropelvic junction obstruction (UPJO) who underwent pyeloplasty using our modified technique of PTLDP between February 2014 and September 2014 at our institution were reviewed. The key steps of our modified method involve identifying the lowest point of the renal pelvis and the lateral aspect of the ureter to guarantee a low pelviureteric and correct orientation anastomosis, and using a 4-0 silk for assistant suturing to avoid crushing of the anastomotic tissue.
  
  
  RESULTS
  All surgeries were successfully completed without conversion. Three patients required an accessory port for the anastomosis. All the patients achieved complete clinical or radiologic resolution after the operation. The mean operative time was 103.4 min, and mean estimated blood loss was 14.4 mL. Mean postoperative differential function of affected kidney was 43.0 ± 16.3 % (range 24-100 %), increased from 39.7 ± 18.0 % (range 18-100 %), preoperatively (p < 0.001). The success rate was 100 % at a mean follow-up of 18.3 ± 2.9 (range 13-25) months.
  
  
  CONCLUSIONS
  Our modified technique of PTLDP is safe and feasible and to allow high success rate for the treatment of pelviureteric junction obstruction in children.
authors: Department of Urology, Bayi Children's Hospital Affiliated to The Military General Hospital of Beijing PLA, No. 5 Nan Mencang, Dongcheng District, Beijing, 100700, China.
authors: Hualin
authors: H
authors: Cao
authors: Department of Urology, Bayi Children's Hospital Affiliated to The Military General Hospital of Beijing PLA, No. 5 Nan Mencang, Dongcheng District, Beijing, 100700, China. huixia99999@163.com.
authors: Huixia
authors: H
authors: Zhou
authors: Department of Urology/State Key Laboratory of Kidney Diseases, Chinese PLA General Hospital/Chinese PLA Medical Academy, Beijing, 100853, China.
authors: Kan
authors: K
authors: Liu
authors: Department of Urology, Bayi Children's Hospital Affiliated to The Military General Hospital of Beijing PLA, No. 5 Nan Mencang, Dongcheng District, Beijing, 100700, China.
authors: Lifei
authors: L
authors: Ma
authors: Department of Urology, Bayi Children's Hospital Affiliated to The Military General Hospital of Beijing PLA, No. 5 Nan Mencang, Dongcheng District, Beijing, 100700, China.
authors: Dehong
authors: D
authors: Liu
authors: Department of Urology, Bayi Children's Hospital Affiliated to The Military General Hospital of Beijing PLA, No. 5 Nan Mencang, Dongcheng District, Beijing, 100700, China.
authors: Tian
authors: T
authors: Tao
authors: Department of Urology, Bayi Children's Hospital Affiliated to The Military General Hospital of Beijing PLA, No. 5 Nan Mencang, Dongcheng District, Beijing, 100700, China.
authors: Xiaolong
authors: X
authors: Luo
authors: Department of Surgery, Beijing United Family Hospital, No. 2 Jiangtai, Chaoyang District, Beijing, 100015, China. karinandwei@hotmail.com.
authors: Wei
authors: W
authors: Cheng
mesh_terms: D000293:Adolescent; D000714:Anastomosis, Surgical / Q000379:methods; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007682:Kidney Pelvis / Q000601:surgery*; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D061646:Operative Time; D016896:Treatment Outcome; D014513:Ureter / Q000601:surgery*; D014517:Ureteral Obstruction / Q000601:surgery*; D013520:Urologic Surgical Procedures / Q000379:methods
keywords: Children; Hydronephrosis; Laparoscopy; Pyeloplasty; Ureteropelvic junction obstruction