Laparoscopic Pyeloplasty: A Comparison between the Transperitoneal and Retroperitoneal Approach during the Learning Curve

Purpose: To compare the transperitoneal and the retroperitoneal approach in the laparoscopic management of pelviureteric junction (PUJ) obstruction, and to find out which approach is preferable during the learning curve period at two different urologic centers. Materials and Methods: We retrospectively evaluated 50 consecutive laparoscopic pyeloplasties performed by two urologists from different urologic centers during their learning curve period in laparoscopy. Each surgeon used a different approach: transperitoneal (group A) or retroperitoneal (group B). Timing for patient positioning, access to the operating field, ureter and PUJ isolation, PUJ suturing, total time of the surgery procedure and blood loss were recorded to compare the transperitoneal with the retroperitoneal approach. Intraoperative complications and perioperative morbidity were also reported. Results: 22 procedures were performed using the transperitoneal method (group A) and 28 using the retroperitoneal method (group B). Significant differences between groups A and B were observed in terms of time for access to the operating field (mean 25 and 15 min, respectively, p < 0.05), time for suturing the PUJ (mean 57 and 103 min, respectively, p < 0.001), and total operative time (mean 127 and 201 min, respectively, p < 0.002). No statistical differences were observed for any other parameters. Average follow-up was 10 and 11 months for groups A and B; no statistical differences were observed. Conclusions: We suggest that young urologists during the learning curve for laparoscopy should perform laparoscopic pyeloplasty using a transperitoneal route. In expert hands, both transperitoneal and retroperitoneal approaches are feasible, and the choice depends on personal preference.