V07-01: Robot assisted laparoscopic extravesical cross-trigonal ureteral re-implantation with tailoring for obstructive mega-ureter.
In this video we describe a technique of robot assisted extravesical cross-trigonal ureteral re-implantation with intra-corporal tailoring of the ureter.
We present a multi institutional study of 20 cases, in this video we describe the case of a 1y/o male who was diagnosed with a left mega-ureter prenatally. US scans showed dilation of renal pelvis and ureter (17mm), MAG3 Renal scan indicated 37% function of the left kidney with delayed drainage. The patient was placed in the supine position. A Foley catheter was inserted to allow bladder distention. Peritoneal access is obtained with the open Hasson technique. 12mm camera port at the umbilicus, 2 robotic 8mm ports and an assistant 5-10mm ports were placed under vision. The distal ureter was identified and dissected distally to the bladder were it is ligated and transected. Ureteral tailoring was performed over a 7FR UK and sutured with a 3-0 V-Loc™. A transverse trough of 4-5cm is created. Emphasis is made to dissect the detrusor to facilitate a tension free closure over the ureter. Bladder mucosa Is opened and uretero-vesical anastomosis is performed with interrupted 5-0 PDS sutures over DJ stent. Detrusor tunnel is closed incorporating the ureter between the mucosa and the detrusor. Water tight closer is verified.
Console time was 180 min. Patient was discharged on POD1, DJ stent was removed 4 weeks post operatively. Imaging showed improvement in hydronephrosis and renal drainage.
Robot assisted cross-trigonal ureteral re-implantation with intracorporeal tailoring is safe feasible and reproducible.