Laparoscopic Pyeloplasty surgery

A laparoscopic pyeloplasty is a minimally invasive procedure done for the removal of a stricture/narrowing from within the upper ureter or the thin tube that connects the kidneys with the bladder (where it connects with the kidney). Lap pyeloplasty is a safe and effective way to correct a blockage of the ureter where it leaves the kidney. Note that this irregularity (blockage) is referred to as UPJ or ureteropelvic junction obstruction, which results in slow and weak urine drainage from the kidney. This condition if not treated early can eventually cause damage to the kidneys.

The laparoscopic approach provides several benefits compared to open surgery, such as: 

• Less pain due to smaller incisions
• Faster laparoscopic pyeloplasty recovery than in an open method
• Shorter hospital stay 
• Lesser scars than an open surgery
• Lower chances of complications

Here is how to prepare for a pyeloplasty laparoscopic surgery :

• You can discuss your medical history, current medications, and supplements if any with your doctor. The doctor will make a note of your symptoms and perform the necessary examinations and tests accordingly.
• Make sure you inform him/her about any know allergies such as allergy to latex or any medications.
• You may be asked to discontinue certain medications such as blood thinners as they may interfere with the healing process and increase the risk of bleeding.
• You may be asked to quit smoking and limit the consumption of alcohol for a brief period before and after the procedure as these habits can delay your recovery.
• Arrange someone for help in order to drive you back after the procedure.
• Make sure to clear all your queries about the procedure beforehand and give yourself ample time to make any necessary arrangements.

Here are the steps of Laparoscopic Pyeloplasty Surgery:

• Anesthesia: The patient is given general anesthesia, which means that they will be asleep and not feel any pain during the procedure.
• Incisions: The patient is positioned on the operating table and the surgeon will make several small incisions in the patient's abdomen, typically ranging from 0.5 to 1.5 cm in length.
• Visualization: A laparoscope (a thin, flexible tube with a camera and light) is inserted through one of the incisions, allowing the surgeon to visualize the inside of the patient's abdomen on a monitor.
• Renal Mobilization: The surgeon will carefully mobilize the kidney and surrounding structures to access the ureteropelvic junction (UPJ), where the obstruction is located.
• Reconstruction: Your doctor will then reconstruct the UPJ, either by removing the narrowed or blocked portion of the ureter and reconnecting the healthy ends or by inserting a stent (a hollow tube)  to widen the area and improve urine flow.
• Closure: Once the reconstruction is complete, the surgeon will remove the laparoscope and surgical instruments and close the incisions with stitches or surgical glue.

Laparoscopic pyeloplasty procedure typically takes between 2-4 hours to complete, depending on the complexity of the surgery. Most patients are able to return home on the same day as the procedure or after a short hospital stay, and can usually resume their normal activities within a few weeks.

The complication and safety rates are similar to the open approach. Potential risks include:

• Bleeding: The procedure holds a risk of bleeding during and after the surgery
• Infection: There is a risk of infection at the incision sites or within the urinary tract.
• Damage to the surrounding structures: Though rare, there is a possibility of injury to the surrounding structures such as the bowel, spleen, liver, lung, vascular structures, pancreas, and gall bladder. 
• Urinary leakage: There is a risk of urine leakage from the ureter after the surgery, which may require additional procedures or a longer hospital stay.

It is essential to discuss these risks and potential complications with your doctor before the surgery and to follow their instructions for aftercare and recovery to minimize the risk of complications.

Here's what you can expect after a Laparoscopic Pyeloplasty:

• You may experience some pain and discomfort in the incision areas, which can last for several days during the pyeloplasty recovery time. Pain medication will be prescribed to manage the discomfort.
• Your doctor will advise you to avoid heavy lifting, and strenuous activities, and exercise for at least two to four weeks after the surgery to allow your body to heal properly.
• You may have a urinary catheter for a short period after the surgery to help drain urine from your bladder.

It may take several weeks or even months for you to fully recover from laparoscopic pyeloplasty. During this laparoscopic pyeloplasty recovery time, it is important to follow your doctor's instructions and take care of yourself to promote healing.

• You may shower and get the wound sites wet, but they should be patted dry.
• Tub baths are not recommended.
• While adhesive strips are not to be removed and fall off themselves, sutures dissolve in 4-6 weeks.
• Avoid prolonged sitting/lying in bed. Walking is advised and climbing stairs is also possible.
• Avoid driving for 1-2 weeks and no heavy lifting for 6 weeks. While you may return to full activity after 3 weeks, 4 weeks may be required to return to work.
• Drink plenty of fluids and consume a regular diet without any restrictions.
• Attend all follow-up appointments and follow the post-operative instructions carefully.

Contact the doctor in the following cases:

• If the wound becomes red, warm, painful, swollen, or continues to discharge
• If your urine gets cloudy and offensive smelling, or you have any other urine infection signs
• Chest pain or shortness of breath
• Severe bleeding in the urine
• High fever and chills
• Nausea/vomiting

It has several benefits making this treatment ideal for UPJ obstruction. Some of these benefits are as follows:

• Prevention of loss of kidney function that may occur because of UPJ.
• Relief from pain and discomfort and improvement in the quality of life.
• Prevention of infections in the urinary system.
• The higher success rate when compared to other UPJ treatments.

One may note that there also exists laparoscopic robotic pyeloplasty. In pyeloplasty robotic surgery, the surgeon uses a robotic arm to perform the procedure.

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