Transperitoneal Laparoscopic Pyelolithotomy: Is the Posterior Pyelotomy Better Than the Anterior? (A Randomized Controlled Clinical Trial)
Trial Snapshot
- Phase
- Not Applicable
- Status
- Completed
- Sponsor
- Damascus University
- Enrollment
- 36
- Locations
- 1
- Primary Endpoint
- Days for oral intake
Study Overview
Brief Summary
Large renal pelvic stones are frequently managed with percutaneous nephrolithotomy (PCNL) but laparoscopic pyelolithotomy (LPL) can be an alternative procedure when performed by skilled surgeons to achieve excellent outcomes in terms of stone free status, operative time, postoperative kidney function, hospitalization duration, and complications.
there are two methods for LPL surgery : Transperitoneal (TLP) and Retroperitoneal (RLP).
RLP associated with shorter mean time for oral intake, and mean hospital stay after surgery.
The surgical exposure in the transperitoneal route for LP is familiar to the majority of surgeons. Also, a much larger working space is available and there are various established anatomical landmarks for performing the surgery effectively. This study introduces a modified technique that creates application of posterior pyelotomy in TLP to achieve the advantages of RLP
Detailed Description
This is a randomized controlled clinical trial that aims to collect a sample within two years from the date of approval of the Scientific Research Council at Damascus University.
The study will focus on a group of patients who will undergo a transperitoneal laparoscopic pyelolithotomy surgery.
The patients will be randomly divided into two groups. The first group will undergo a traditional transperitoneal laparoscopic pyelolithotomy, which involves application of anterior pyelotomy.
The second group will receive a modified transperitoneal laparoscopic pyelolithotomy, which involves application of posterior pyelotomy.
The data will be compared between the two groups in terms of the mean duration of surgery ,mean time for oral intake ,and mean hospital stay
Study Design
- Study Type
- Interventional
- Allocation
- Randomized
- Intervention Model
- Parallel
- Primary Purpose
- Treatment
- Masking
- Double (Participant, Outcomes Assessor)
Eligibility Criteria
- Ages
- 15 Years to 65 Years (Child, Adult, Older Adult)
- Sex
- All
- Accepts Healthy Volunteers
- No
Inclusion Criteria
- •Patients with large renal pelvic stone > 2 cm .
- •failure of minimally invasive approaches such as PCNL or ESWL
- •stones that were neither amenable to ESWL nor were ideally suitable for PCNL
- •Patient's preference for a quick one-stage procedure.
- •Negative urine culture
Exclusion Criteria
- •Patients refusing study participation.
- •Contraindication to general anesthesia.
- •Contraindication to laparoscopic surgery.
- •Patients with an intrarenal pelvis.
- •Previous surgical on the same kidney.
- •Associated anatomical deformity.
Arms & Interventions
Anterior Pyelotomy
Traditional transperitoneal laparoscopic pyelolithotomy:
Patients who were randomized to receive classic transperitoneal laparoscopic pyelolithotomy
Intervention: traditional transperitoneal laparoscopic pyelolithotomy (Procedure)
Posterior Pyelotomy
Modified transperitoneal laparoscopic pyelolithotomy:
Patients who were randomized to receive modified transperitoneal laparoscopic pyelolithotomy by applying posterior pyelotomy.
Intervention: modified transperitoneal laparoscopic pyelolithotomy (Procedure)
Outcomes
Primary Outcomes
Days for oral intake
Time Frame: Up to one week after surgery
the number of days to start introducing oral fluids and food after surgery with good acceptance, and without vomiting or flatulence. It will be measured in the outcome by the mean
Postoperative urine leak
Time Frame: up to three days after surgery
considered to be present when the drain contained \>30 cc of urine the morning after surgery. It is measured by answering the question: Is there any urinary leakage, yes or no? It will be measured in the outcome by the ratio
Days of hospital stay
Time Frame: up to ten days after surgery
the number of days the patient stayed in the hospital after surgery. It will be measured in the outcome by the mean
Operative time
Time Frame: at the end of surgery in the operating room
the duration of the surgical procedure. It is measured by minutes, and calculated from establishing the pneumoperitoneum until the surgery is completed by suturing the skin. It will be measured in the outcome by the mean
stone-free status
Time Frame: Up to one week after surgery
postoperative radiological imaging demonstrating evidence of residual stones It will be measured in the Outcome by the ratio
Secondary Outcomes
No secondary outcomes reported