V04-09: Robotic Assisted Laparoscopic Upper Pole Moiety Ureterectomy
The purpose of this video is to present a novel application of robotic surgery by removing a ureteral remnant of a vaginally inserting left ectopic ureter following a prior upper pole hemi-nephrectomy had been performed for a non-functioning and obstructed system.
A 32 year old female presented to the Emergency Department with purulent vaginal drainage, fevers, and pain. CT imaging demonstrated an infected left upper pole remnant and ureteral dilation. Percutaneous drainage and antibiotics cleared the infection. A MAG-3 renal scan demonstrated 21% split function of the lower pole remnant. To preserve renal function a robotic-assisted laparoscopic upper pole moiety ureterectomy was scheduled.
After being placed in the right lateral decubitus position the robotic ports were placed in the standard fashion. The renal hilum was identified. Dissection planes between the upper and lower pole moieties and ureters were delineated. This allowed the upper pole renal pelvis and ureter to be freed from remaining kidney. The renal pelvis and ureter were then placed on traction to aid in the inferior dissection. The ureter was traced over the common iliac to its insertion in the vagina and a traction stitch was placed. The most distal end of the ureter was clipped and excised with the remnant renal pelvis. The specimen was removed and the vaginal defect was closed in two layers. The patient progressed well on the floor and was discharged home on post-operative day one.
This video represents a unique application of robotic surgery to remove a vaginaly inserting left ectopic ureteral remnant even after prior partial nephrectomy had been performed.