Laparoscopic pyeloplasty Surgery
Laparoscopic pyeloplasty is a least invasive surgical method which is used to remove blockage from the base of the kidney. Pyeloplasty is useful for patients suffering from UTI, urination problems, abdominal pain and kidney stones too.
An endoscope (small and flexible surgical tube) is used to insert a powerful but tiny video camera, miniature surgical tools and stent implant into the body through very small incisions. These are useful to repair tissue damage efficiently. Mostly, laparoscopic pyeloplasty is usually performed within 3 hours and the patient recovers completely within the month.
A laparoscopic pyeloplasty may be advised for clearing an obstruction in the UPJ. Ureteropelvic Junction (UPJ) is the point where the base of the kidney joins the ureter. A blockage in this portion, caused by narrowing of the upper ureter tube, can result in the urine to flow back into the kidney. This can lead to potentially severe health complications.
A laparoscopic pyeloplasty is normally advised once the doctor performs several detailed physical examinations and diagnostic imaging tests which attest to a physical obstruction in the UPJ.
The doctor and surgeon will discuss all possible outcomes, potential risks and other aspects before starting the procedure.
How to prepare for the Laparoscopic Pyeloplasty?
Patients are normally advised to refrain from eating food or drinking fluids from the night prior to the laparoscopic pyeloplasty.
Who is an ideal candidate for a Laparoscopic Pyeloplasty?
A person who has a blockage in the UPJ is likely a candidate for a laparoscopic pyeloplasty. This condition may be due to a congenital (birth) defect, such as fibrous scarring from prior stone or surgery, horseshoe kidney, etc. This condition may also be the result of a blood vessel which may cause the UPJ to get jammed or if a stone gets stuck in the upper portion of the ureter.
The surgeon will also check your age, overall health condition as well as realistic expectations to determine if you are an ideal candidate for a laparoscopic pyeloplasty.
How is Laparoscopic Pyeloplasty performed?
The laparoscopic pyeloplasty requires administering general anesthesia to prevent pain or discomfort to the patient during the minimally invasive surgical procedure. The lower part of the abdomen is sterilized and shaved.
The surgeon will make a small incision (about 4 mm-long) in the cleaned abdominal region. This incision is the entry-point of the endoscope, which is a small and flexible surgical tube capable of carrying powerful tiny video cameras, light source and other miniaturized surgical instruments inside the body. The video camera attached to its end provides the surgeon a clear view of the obstruction or narrowed portion of the UPJ. This is helpful in successfully implanting a stent between the kidney and one of the incisions in the abdomen to help drain additional urine and blood while the surgery is underway.
Once the stent is in place, the surgeon will use tiny surgical tools to excise (surgically remove) the obstructed/narrowed part of the ureter along with the damaged tissues through another similar small incision in the same abdominal area.
The surgeon will then rejoin the base of the kidney to the functional part of the remainder of the ureter using special fine sutures.
Once satisfied with the operation, the surgeon will remove the endoscope and surgical tools to close the incision wounds using bandages.
What are the advantages of Laparoscopic Pyeloplasty?
These are the distinct advantages that the minimally invasive laparoscopic pyeloplasty will give the patient:
Shorter stay in hospital following surgery
Overall aesthetically appealing results
What is recovery like following a Laparoscopic Pyeloplasty?
The nursing staff will shift you into the recovery room immediately following the laparoscopic pyeloplasty, for a few hours at least. This is essential to monitor your vital signs and check for signs of complications from the surgery.
The doctor will usually advise a stay in the hospital for at least 1 to 2 days, during which time painkillers are administered to alleviate pain while antibiotics are given to prevent infection in the incision wounds.
The surgeon will remove the stent normally after 4 to 6 weeks following the date of surgery. It is advised against engaging in strenuous physical activities for at least a couple of weeks following the surgery. The doctor will advise on being mobile and performing simple breathing exercises to avoid respiratory infections.
You can resume normal daily activities within 2 to 4 weeks following the surgery.
Are there any risks of complications from Laparoscopic Pyeloplasty procedure?
Although laparoscopic pyeloplasty is significantly safe, there are still risks associated with the surgical aspect of the treatment. These are the rare risks that may arise following a laparoscopic pyeloplasty:
Bleeding – There is significantly less blood loss as compared to conventional surgical procedure and there is no need for blood transfusion to be administered.
Infection – A comprehensive antibiotic is administered before the surgery to prevent infection of various kinds.
Hernia – Incision site may develop hernia in rare cases.
Organ injury/tissue damage – Although not so common, this complication may result from the surgical instruments being used inside the body. This may lead to injuring muscles or nerves, depending on the location.
Transforming into open surgery – In case it becomes difficult to perform the surgery using laparoscopic technique, the surgeon may choose to adopt the conventional open-type surgical procedure to complete the operation.
Unsuccessful removal of UPJ blockage – Around 3% of patients undergoing this operation may develop another blockage due to scarring of the tissue. This may require an additional surgery to correct it.