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Prof. Dr. Ali Avanoğlu
UPJ Obstruction • Pyeloplasty and approaches

Laparoscopic Pyeloplasty: UPJ Repair Through a Closed (Keyhole) Approach

Laparoscopic pyeloplasty is the Anderson–Hynes repair for UPJ obstruction performed through several small openings, into the abdominal cavity or behind the kidney, using a camera and fine instruments. This page explains who it suits, how surgery proceeds, and its limits.

Who this is forFamilies of older children or adolescents, and adults, who have been recommended closed pyeloplasty
Reading≈5 min
ByProf. Dr. Ali AvanoğluUpdated
This page is part of UPJ obstruction.Read the full treatment overview on the hub page
narrow segmentwide pelvisBEFORE: wide pelvis, narrow UPJANDERSON–HYNES · BEFOREwide funnel sutureJJ stent (4–6 weeks)urine flows freelyAFTER: funnel-shaped wide junctionANDERSON–HYNES · AFTERLAPAROSCOPIC
narrow segmentwide pelvisBEFORE: wide pelvis, narrow UPJANDERSON–HYNES · BEFOREwide funnel sutureJJ stent (4–6 weeks)urine flows freelyAFTER: funnel-shaped wide junctionANDERSON–HYNES · AFTERLAPAROSCOPIC
pyeloplasty before/after; laparoscopic approach icon (3 ports)
01 · What does laparoscopic pyeloplasty mean?02 · Who is it suited for, who is it harder for?03 · How does surgery proceed?04 · Hospital stay, pain, and return to daily life05 · Laparoscopic or robotic?
In brief5 madde
  • What does laparoscopic pyeloplasty mean?: Laparoscopy is creating a working space by inflating the abdomen with gas and operating through several millimeter-sized openings with a camera and instruments.
  • Who is it suited for, who is it harder for?: The laparoscopic approach is most comfortably applied in older children with a roomier abdominal cavity, adolescents, and adults.
  • How does surgery proceed?: Under general anesthesia the child is positioned on their side; there are two routes to the kidney.
  • Hospital stay, pain, and return to daily life: The advantage of the closed method that families notice most is in the first days after surgery.
  • Laparoscopic or robotic?: Robotic pyeloplasty is the laparoscopic operation performed with robotic arms; the three-dimensional view and wrist-articulated instruments make suturing easier.
01

What does laparoscopic pyeloplasty mean?

Laparoscopy is creating a working space by inflating the abdomen with gas and operating through several millimeter-sized openings with a camera and instruments.

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  • In UPJ obstruction (ureteropelvic junction obstruction; informally, kidney outlet narrowing), laparoscopic pyeloplasty applies the exact same steps as open surgery: the narrow segment is removed, and the ureter is reattached to the pelvis. The difference is in the route: generally three small openings are used instead of one incision, and the view is watched magnified on a screen.
  • Per guideline data, laparoscopic pyeloplasty's success and complication rates are comparable to open surgery; the stay is shorter, pain is less, and the cosmetic result is better. On the other hand, suturing is technically harder than in open surgery and the learning curve is long; outcomes are therefore closely tied to center experience.
02

Who is it suited for, who is it harder for?

The laparoscopic approach is most comfortably applied in older children with a roomier abdominal cavity, adolescents, and adults.

  • A good candidate: school-age children and older, adolescents, adults; unilateral narrowing; suspected crossing vessel (the vessel is well seen with the camera).
  • Cases requiring extra care: infants under one year old and of low weight (a tight working space), previous abdominal surgery and adhesions, a very large pelvis or a small pelvis buried within the kidney, redo cases (possible at experienced centers).
  • In infants under one year old, experienced centers have reported perioperative outcomes similar to open surgery; but at many centers, a small open incision remains standard in infants. The choice of method is not a single fixed answer; it is made according to age, weight, anatomy, and team experience.
03

How does surgery proceed?

Under general anesthesia the child is positioned on their side; there are two routes to the kidney.

  • Transperitoneal (through the abdominal cavity) route: a wider space, familiar anatomy; the bowel is moved aside to reach the kidney. This is the most commonly chosen route in children.
  • Retroperitoneal (behind the kidney) route: the peritoneum is not opened, the space is narrower; some centers prefer this route.
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  • Once the camera and instruments are placed, the pelvis and upper ureter are freed; a crossing vessel, if present, is preserved and the ureter is rerouted in front of it. The narrow segment is removed, the end of the ureter is split open (spatulation), and it is sewn to the pelvis with fine dissolvable sutures. Most surgeons place a JJ (double-J) stent during surgery; the stent can be placed beforehand via cystoscopy or fed in through a port. The gas is released and the openings are closed with a few stitches; from the outside, usually only strips of tape are visible.
  • Rarely, surgery is converted to an open operation because of bleeding, adhesions, or an inability to suture safely (conversion); this is not a failure but a safety decision, and it is explained to the family before surgery.
04

Hospital stay, pain, and return to daily life

The advantage of the closed method that families notice most is in the first days after surgery.

  • See a doctor: fever (38°C/100.4°F or above), increasing abdominal or flank pain, a swollen and distended abdomen, vomiting, drainage at the port sites, decreased urine output.
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  • Pain is generally less; shoulder pain from the abdominal gas can occur in the first day or two and resolves on its own. The length of stay varies by center but is generally somewhat shorter than with open surgery. Feeding starts on the first day; school and light activity resume within a few weeks, contact sports with the team's approval.
  • If a JJ stent was placed, it is removed roughly 4–6 weeks later (2–8 weeks depending on the center) under a brief anesthetic via cystoscopy; while the stent is in, frequent urination, burning, and mild blood-tinged urine are common.
05

Laparoscopic or robotic?

Robotic pyeloplasty is the laparoscopic operation performed with robotic arms; the three-dimensional view and wrist-articulated instruments make suturing easier.

  • Guidelines find the success and complication rates of the two closed methods comparable; with robotic surgery, cost and instrument size are limiting factors. In adults, the first-choice options are laparoscopic or robotic pyeloplasty. Which closed method is chosen is mostly determined by the center's equipment and experience; in adolescents and adults, the choice of closed method is made through the joint evaluation of two specialists.
UPJ Obstruction video guide3 short videos, in order
Frequently asked questions
Is success lower with the closed method?
No. Per guideline data, success and complication rates are comparable to open surgery (roughly 90–95% or higher). The outcome is tied to center experience; because it is technically more demanding, the learning curve is longer.
Is laparoscopic pyeloplasty done in infants?
It is performed under one year of age at experienced centers, with results reported as similar to open surgery. However, a small open incision remains standard at many centers for infants, and the incision is already small. This is why the choice of method in infants varies by center.
Is entering through the abdomen risky for the bowel?
In the transperitoneal route the bowel is only moved aside; injury is very rare. Temporary bowel sluggishness can occur after surgery, and feeding usually starts on the first day. The retroperitoneal route avoids this contact entirely; which route is chosen depends on the surgeon's experience.
What happens if surgery is converted to open during the operation?
Conversion is rare and is done for safety; the repair is completed in the same session through the open route. The outcome is the same as if the surgery had been done open from the start. This possibility is always discussed at the pre-surgery consultation.
←Previous • Pyeloplasty and approachesOpen Pyeloplasty: Repair Through a Small Incision in InfantsNext • Pyeloplasty and approachesRobotic Pyeloplasty→
Related pagesFull index →
Pyeloplasty and approachesRobotic PyeloplastyRobotic pyeloplasty is the Anderson–Hynes repair for UPJ obstruction performed through several small openings, with the surgeon controlling robotic arms from a console. This page explains what the word "robot" actually means, and at which ages and in which situations it stands out.Pyeloplasty and approachesOpen vs. Laparoscopic vs. RoboticIn UPJ obstruction, all three approaches perform the same operation (Anderson–Hynes pyeloplasty) through different routes of access. This page lays open, laparoscopic and robotic pyeloplasty side by side — on success, pain, hospital stay, scarring, age and cost — without taking sides.By age, and special situationsUPJ Obstruction in Adults: Symptoms, Evaluation, TreatmentUPJ obstruction in adults is most often a narrowing that has been present since childhood and only becomes symptomatic late — showing up as flank pain, recurrent infection, or a kidney stone. This page summarizes evaluation and treatment options in adults, noting that it draws on review data rather than a formal guideline.After surgery and follow-upJJ (Double-J) StentA JJ (double-J) stent is a temporary, thin tube placed between the kidney and bladder after pyeloplasty; it keeps the newly rejoined junction open while it heals. How long it stays in a child, which symptoms are normal, and how it's removed are among the questions families ask most.
UPJ Obstruction topic clustersMain treatment page →
Basics 7Diagnosis and evaluation 6Follow-up or surgery? 7Conservative follow-up 5Pyeloplasty and approaches 7After surgery and follow-up 6By age, and special situations 7
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