Laparoendoscopic Single-Site (LESS) Pyeloplasty for Horseshoe Ureteropelvic Junction Obstruction

Background and Objective: Pyeloplasty in horseshoe kidneys can be challenging due to aberrant vasculature, renal malrotation, and ectopic location. Fewer than 20 cases of minimally invasive (MIS) pyeloplasty in horse-shoe kidneys have been reported in the literature to date. We herein report the first 2 cases of laparoendoscopic single-site (LESS) pyeloplasty for UPJ obstruction in horse-shoe kidneys. Methods: Two patients with symptomatic ureteropelvic junction obstruction in horseshoe kidneys were treated with an Anderson-Hynes LESS pyeloplasty. This was per-formed using three 5-mm trocars through a single umbil-ical incision, plus an accessory 3-mm port at the anterior axillary line to facilitate suturing and subsequent drain placement. Results: Both patients had BMI 23. The operative times were 204 minutes and 171 minutes. Blood loss was neg-ligible, and no intraoperative complications occurred. To date, 9-month renography for patient 1 demonstrates sta-ble renal function and unobstructed drainage. After stent removal, patient 2 was asymptomatic. Conclusion: In experienced hands, LESS reconstructive techniques are applicable to complex renal anomalies. LESS pyeloplasty for UPJ obstruction associated with horseshoe kidneys is feasible, safe, and effective in select patients