New Surgical Instruments Facilitate Laparoscopic Pyeloplasty

A new set of instruments has been designed to overcome some difficulties and technical challenges encountered during pure laparoscopic pyeloplasty (LP).

Researchers at Changhai Hospital, Second Military Medical University (SMMU; Shanghai, China) and the Cleveland Clinic (OH, USA) designed the new instruments, which include right angle laparoscopy scissors, a petal-shape ureter dilator, and a guide tube. Four experienced laparoscopic experts then tried them on live pigs. After general anesthesia was administered, transperitoneal ureteroureterostomy was performed using standard laparoscopic instruments, including placing an anterograde double J-stent. Then, the opposite lateral was done by the same surgeon using the new devices for side-by-side comparative analysis.


The procedures were all technically successful. All experts were then interviewed to assess the new instruments by a questionnaire based on a 1-10 visual analog scale (VAS). The right angle laparoscopy scissors and the guide tube were accepted by all participants, with the help score at 6.75 and 4.25 respectively, while the new difficulty score was 1.25 and 1.75. However, the petal-shape ureter dilator only received 1.5 help score and 6.5 new difficulty score; one of surgeons recommended that a stone basket was more suitable.

“Two of these new tested instruments, the right angle laparoscopy scissors and the guide tube may be helpful to minimize some difficulties in pure laparoscopic pyeloplasty,” concluded lead author Wen-Zheng Chen, MD, of the Changhai Hospital department of urology, and colleagues. “Further research is warranted to further refine these tools and to design new valuable instruments.”

Pyeloplasty is the surgical reconstruction or revision of the renal pelvis to drain and decompress the kidney because of ureteropelvic junction obstruction (UPJO). Open pyeloplasty has been historically described as the gold standard for the surgical treatment of UPJO , although new techniques, such as LP, endopyelotomy, and robot-assisted laparoscopic pyeloplasty (RALP) have recently gained more popularity, despite a steep learning curve with current laparoscopic instruments.

Related Links:
Changhai Hospital, Second Military Medical University
Cleveland Clinic