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LAPAROSCOPIC PYELOPLASTY: IMPACT OF 3D VISION LAPAROSCOPY AND
ARTICULATING SHEARS
John-Paul CAPOLICCHIO, Talal AL-QAOUD , Hiba ABOU-HAIDAR , Roman JEDNAK, Alex BRZEZINSKI and Mohamed EL-
SHERBINY
McGill University, Department of Paediatric Surgery, Division of Paediatric Urology, Montreal, CANADA
INTRODUCTION
To compare outcomes of laparoscopic pyeloplasty in a cohort of children with 3D vision laparoscopy and articulating
shears to a cohort with standard 2D laparoscopy
PATIENT AND METHODS
A retrospective chart review of 33 consecutive patients with ureteropelvic junction obstruction who underwent
laparoscopic pyeloplasty by a single surgeon from 2006 to 2013. The current 3D cohort (n=8) was compared to the
previous 2D cohort (n=19), excluding cases from 2001-2005 to account for the learning curve. Descriptive data and
operative time, dimension, presence of a crossing vessel, length of hospital stay, and complication rate were compared
between the two groups. Articulating shears were used for pelvotomy and spatulation of the ureter. Statistical tests
included linear regression models and chi square tests for trend
RESULTS
The median age and weight of the population was 7.5 yrs and 28.5kg. Operative time per case was decreased by an
average of 48 minutes in the group undergoing 3D laparoscopic surgery compared to the group undergoing 2D
laparoscopic surgery (p=0.02). When adjusted for the presence of a crossing vessel, operative time was still significantly
shorter in the 3D group (p=0.03). There was no difference in median age, weight, or presence of crossing vessel
between both groups. Complication rate and length of hospital stay were not significantly affected by the use of 3D
laparoscopy. The majority (7 out of 8) of 3D cases where performed using the laparoscopic flexible scissors, which was
significantly associated with operative time (p=0.02)
CONCLUSIONS
The use of 3D vision laparoscopy and articulating shears for pyeloplasty in children appears to significantly reduce the
operative time compared to conventional 2D laparoscopy with rigid scissors. The use of 3D vision endoscopy with
articulating instruments blurs the distinction between current robotic assisted and conventional laparoscopic technology,
and provides an alternative hybrid deserving of further attention