The Three-Trocar Laparoscopic Pyeloplasty: Tips and Tricks on Technical Aspects

Abstract Introduction: Laparoscopic pyeloplasty (LP) is the first-line option for management of ureteropelvic junction obstruction (UPJO).1,2 Initially, this procedure was described using four or five ports; however, newer approaches use three-trocars aiming for minimal invasion,3,4 which may complicate the procedure. We present a video of the three-trocar technique step by step, with several tips and tricks to improve the performance. Patients and Methods: Seven patients (mean 44 years old range: 31–58) underwent Anderson-Hynes three-trocar LP for symptomatic UPJO. The three-port transperitoneal technique was done. A 10-mm trocar was placed directly through the umbilicus and two 5-mm trocars in a triangular arrangement. To improve exposure of the UPJ and reduce the dissection time, the surrounding tissues may be retracted with clips or sutures applying the puppet maneuver, with special caution to avoid incorporating the bowel into the retraction devices. The proximal ureter may be lifted with similar man...