Laparoscopic Pyeloplasty Lecture by Dr R K Mishra

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A laparoscopic pyeloplasty removes the stricture by using laparoscopic equipment. Long thin instruments are passed through five small incisions made in the flank, each about 1cm in length. The abdomen is first filled with carbon dioxide, which separates the tissues to allow for vision during the surgery. A camera is then passed, giving the urologist a detailed picture inside the abdomen. The other openings are used to pass cutting and suturing instruments so the stricture can be isolated, removed and the two remaining ends stitched together widely to prevent the stricture reoccurring. In both cases, a wound drain is then placed to drain any ooze from the area and a nephrostomy tube may also be put in. A nephrostomy tube is a drain that is placed into the kidney through the same incision used to remove the stricture. It is stitched into place and is connected to a drainage bag that drains any urine or blood from the kidney. A ureteric stent is also placed. This thin, soft tube sits within the ureter. Both ends of the stent are curled with one loop sitting within the kidney and the other within the bladder. The stent allows healing to take place and drains the urine from the kidney. A catheter (a flexible drainage tube) is also placed through your urethra to drain your urine from the bladder into a bag and remains in place until you are up and about.