LAPAROSCOPIC URETERAL REIMPLANTATION – VIDEO

Overview

Introduction:
Reimplantation of the ureter is relatively rare surgery and even in paediatric urology. The standard procedure is open access. Expanding experience with laparoscopy including robotically assisted allows minimally invasive performance. We present our first experience with laparoscopic reimplantation.

Material:
From 3/2014 to 6/2015 laparoscopic reimplantation was performed four times. Twice as a part of laparoscopic diverticulectomy of urinary bladder (once along with photoselective vaporization of the prostate, once with radical prostatectomy), once for a lesion of the ureter in a 43 year old woman two months after open hysterectomy for myomas and once in a 34 year old man with stenosis of the distal ureter. This video presents a case of ureteral injury after hysterectomy.

Video case report:
Laparoscopic approach in Trendelenburg position is performed using 4 ports. Peritoneum is opened paravesically and the right ureter is dissected to the bladder wall. The ureter is released from the stenosis. An unsuccessful attempt at probing the ureter by flexible cystoscope is made. The ureter is cut above the stenosis. The bladder is opened and the ureter is reimplanted using polyglactin 4-0 stitches without antirefux mechanism. Prior to the completion of the anastomosis the „double loop“ ureteral stent is placed using a hydrophilic wire. At the end of the procedure the drain is placed into the Pouch of Douglas. Operation time was 150 minutes, blood loss was 150 ml. The nephrostomy was removed on the fourth postoperative day, urinary catheter was removed on the sixth postoperative day and the stent after 4 weeks. There is no hydronephrosis on ultrasonography two years after surgery, functional scintigraphy (99mTc MAG3) is imperceptibly improving (split function 28 % to 30 %).

Conclusion:
Laparoscopic reimplantation is a less invasive alternative to open surgery in selected cases.

Key words:
Ureter, trauma, laparoscopy, reimplantation.