신우요관이행부폐색 환자에서 로봇보조 복강경 수술을 포함한 복강경 신우성형술의 경험
Experience with Laparoscopic Pyeloplasty, Including Robot-Assisted Laparoscopic Surgery, for Ureteropelvic Junction Obstruction
김성철, 강태진, 박형근,
소속 상세정보
김성철 ( Kim Seong-Chul )
울산대학교 의과대학 비뇨기과학교실
강태진 ( Kang Tae-jin )
울산대학교 의과대학 비뇨기과학교실
박형근 ( Park Hyung-Keun )
울산대학교 의과대학 비뇨기과학교실
KMID : 0358320090500100996
Abstract
Purpose: Laparoscopic pyeloplasty was developed as a minimally invasive alternative to an open procedure for the treatment of ureteropelvic junction (UPJ) obstruction. We present our experience with the first 30 consecutive cases of laparoscopic pyeloplasty performed at our institution.
Materials and Methods: We studied 30 patients with ureteropelvic junction obstructions who underwent laparoscopic pyeloplasty between March 2004 and March 2009. Of the 30 patients, 5 patients underwent robot- assisted laparoscopic pyeloplasty (RALP) since April 2008. Patients were divided into 4 groups according to operative procedure: group 1, early laparoscopic pyeloplasty-dismembered (E/LP-D, n=9); group 2, late laparoscopic pyeloplasty-dismembered (L/LP-D, n=9); group 3, laparoscopic pyeloplasty-Fenger’s method (LP-F, n=7); and group 4, RALP (n=5).
Results: The mean age of the patients was 34.0±12.8 years (range, 17-61 years). A crossing vessel was present in 37.9% of cases. Mean follow-up was 30±14 months (range, 11-62 months). Mean operative time was 267.3±78.7 minutes (range, 154-460 minutes), and the average length of the postoperative hospital stay was 4.6±1.6 days (range, 3-10 days). There were no intraoperative complications or transfusion. The success rate was 73.3%. The success rates of E/LP-D, L/LP-D, LP-F, and RALP were 6/9 (66.7%), 7/9 (77.8%), 5/7 (71.4%), and 4/5 (80%), respectively, without significant difference (p＞0.05). Operation time and length of hospital stay were shorter in the L/LP-D group than in the E/LP-D group.
Conclusions: Laparoscopic pyeloplasty may be an alternative treatment for an ureteropelvic junction obstruction, but the technical complexity of the procedure has made it difficult for many surgeons to adopt. RALP is a technically feasible management option for UPJ obstruction.
키워드
Laparoscopy;Ureteral obstruction;Robotics
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