COMPARISON OF ADULT AND PEDIATRIC LAPAROSCOPIC PYELOPLASTY1468

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The learning curve for laparoscopic pyeloplasty isgenerally long and steep. Especially intracorporealsuturing in the restricted space is a technically de-manding skill that requires a long time to master.Therefore, establishment of an easily availabletraining system for pediatric laparoscopic surgery isneeded.

At our institution a surgeon performed laparo-scopic nephrectomy and adrenalectomy in morethan 50 adults as an operator or assistant beforeperforming laparoscopic pyeloplasty. In Japan theEndoscopic Surgical Skill Qualification System forurological laparoscopy was established in 2003.1 Themain goal of the system is to decrease complicationsand promote safer surgical procedures. Assessmentguidelines of the system were a useful guide for us tomaster the standard techniques of laparoscopic pro-cedures. In addition, training exercises for suturingskill using dry laboratory models and live animalsfacilitated the initial performance of laparoscopicpyeloplasty. Laparoscopic internal ring closure after

REFERENCES

orchiectomy and subsequent internal ring closure 16: 115.

useful as a training procedure for suturing.2 How-ever, even after these experiences laparoscopic py-eloplasty in children remained challenging for usbecause of the greater dexterity required. As theJapanese guidelines for urological laparoscopic sur-gery describe, we initially confined laparoscopic py-eloplasty to adults and older children, although theminiaturization of laparoscopic equipment has al-lowed the indications to be extended to include in-fants.3 Consequently performance of laparoscopicpyeloplasty in adults and children has provided uswith valuable knowledge and experience that hasenabled us to improve our surgical skill, as we con-cluded in this article.

The most important issues in medical trainingare functional outcome and patient safety.4 Al-though pediatric laparoscopic pyeloplasty is rapidlybecoming an acceptable procedure, to define betterthe real value as a minimally invasive surgery andgold standard procedure, the most efficient teachingand learning system for pediatric laparoscopic uro-

laparoscopic orchiopexy and orchiectomy was also logical surgery should be established.

1. Matsuda T, Ono Y, Terachi T et al: The EndoscopicSurgical Skill Qualification System in urologicallaparoscopy: a novel system in Japan. J Urol 2006;

176: 2168.

2. Kojima Y, Mizuno K, Imura M et al: Laparoscopic

for extra-abdominal testicular nubbin in children.Urology 2009; 73: 515.

3. Tanaka M, Ono Y, Matsuda T et al: UrologicalLaparoscopic Surgery Guideline Committee, Japa-nese Society of Endourology and ESWL. Guidelinesfor urological laparoscopic surgery. Int J Urol 2009;

4. Stolzenburg JU, Schwaibold H, Bhanot SM et al:Modular surgical training for endoscopic extraperi-toneal radical prostatectomy. BJU Int 2005; 96:1022.