V1-05: Intraperitoneal robotic assisted laparoscopic excision of an upper pole ureterocele and Cohen cross-trigonal ureteral reimplantation of a duplicated system
Video
INTRODUCTION
Ureteral reimplantation has typically been performed in an open fashion, particularly in cases with complex anatomy, such as duplication or the presence of a ureterocele. Advances in robotic techniques have allowed for complex reconstruction to be performed in a minimally invasive fashion. This video demonstrates several techniques including ureterocele excision, tapering of a dilated ureter, and cross trigonal reimplantation demonstrating the safe and effective application of robotic reconstructive surgery._x000D_
METHODS
The patient is a 19 year old female with a complete ureteral duplication on the left side, an obstructing ureterocele of the upper pole moiety and recurrent episodes of pyelonephritis. After undergoing transurethral incision of the ureterocele, she continued to have episodes of pyelonephritis and the voiding cystourethrogram demonstrated Grade III reflux into the upper pole system. Intraoperatively, the duplicated ureters were isolated on the left side and dissected extravesically to the level of the ureterovesical junction. The bladder was then bivalved and a Keith needle was used to secure the bladder edges to the lateral abdominal wall. The duplicated left ureters were then mobilized within a common sheath intravesically and released from the underlying detrusor muscle and the bladder mucosa. The dilated upper pole ureter was tapered. Sharp dissection was then used to create a submucosal cross trigonal tunnel. The ureters were then reimplanted employing the Cohen transtrigonal technique. Two double pigtail ureteral stents were placed into each ureter . The native hiatus and the posterior bladder wall were reconstructed and bladder mucosa reapproximated. The bivalved bladder was closed in standard two layer fashion. A foley catheter was left in place for 7 days._x000D_
RESULTS
The patient had an unremarkable postoperative course and was discharged with a Foley catheter. Her postoperative cystogram one week later demonstrated no evidence of urinary leak. Her catheter was removed with the ureteral stents to be removed 4 weeks postoperatively. _x000D_
CONCLUSION
Robotic techniques can be utilized to facilitate a combined extravesical and intravesical approach to complex ureteral reconstruction. The key technical principles to this procedure include adequate use of retraction sutures for intravesical exposure and ureteral tapering._x000D_
Funding: None