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[Modified laparoscopic scissors: a new instrument for performing endopyelotomy].

OBJECTIVE
The safety and success of antegrade endopyelotomy in the treatment of ureteropelvic junction (UPJ) stenosis have been documented in numerous literature reports over the last decade. We show a new available alternative to the way incision is performed.


METHODS
Endopyelotomy with modified laparoscopic scissors was performed in 18 patients; 12 presented with primary obstruction and 6 with secondary obstruction. 3 mm laparoscopic scissors with one end sharpened and adapted for this technique are introduced through a nephroscope. A small puncture through the renal pelvis wall is made in the posterolateral position using the scissors' end. After that, scissors are opened under permanent endoscopic control as far as to visualization of the peripyelic space, continuing then with the internal edge of the scissors down to the UPJ. Visual control allowed us to coagulate any vessel and to avoid the bigger calibre ones. At the end of the procedure an endopyelotomy stent was placed over the safety guide wire.


RESULTS
Results were good in 17 patients (94%); symptomatic relief and adequate pass of contrast to proximal ureter were observed in the remaining case, although pyelocalicilar dilation was not improved. Three vessels adjacent to the UPJ (16.6%) were discovered through the performed pyelotomy incision. Operative times were lower than 2 hours. Blood losses were minimal and patient recovery uneventful allowing hospital discharges within 48 hours.


CONCLUSIONS
To use 3 mm laparoscopic scissors allows to perform endopyelotomy without changing endoscopes, precisely cutting due to retroperitoneum visualisation, and offers the chance to coagulate small calibre vascular elements and to avoid those of bigger size.