V10-05: Robotic-assisted laparoscopic transureteroureterostomy
VideoIntroductions and Objectives
Developed in the 1930s, transureteroureterostomy (TUU) is a well-established procedure used for a variety of urologic disease processes. The utility of TUU becomes apparent when a shortened, irreparable, or damaged ureter precludes conventional repair. A novel approach to this procedure is a robotic-assisted approach. This teaching video will demonstrate positioning and operative technique for this procedure.
This particular case involves a 28-year-old woman with a complex urologic history including bilateral ureterovesical junction obstructions at birth that were repaired in infancy with bilateral ureteral reimplants. She subsequently developed left ureterovesical junction obstruction and underwent a robotic-assisted laparoscopic left ureteral reimplantation with a psoas hitch. After a lengthy period of recurrent urinary tract infections (UTIs), abdominal pain, and persistent hydronephrosis, a robotic-assisted laparoscopic TUU was presented as a treatment option.
After placement of 3 laparoscopic ports the patient was positioned in steep Trendelenburg position. The robotic surgical system was then docked between the patient's legs. Both ureters were identified and mobilized from the retroperitoneum in the setting of significant scarring. The left ureter was transected distally, brought through a defect created in the sub-sigmoid mesentery and re-anastomosed end-to-side with the right ureter. She tolerated the procedure well. Her post-operative course was complicated by a UTI. At 3 months, a renal ultrasound revealed mild bilateral hydronephrosis that resolves with voiding.
The accompanying teaching video demonstrates positioning and operative technique for a robotic-assisted laparoscopic TUU. This innovative and minimally invasive technique is a safe and feasible approach to manage ureteral reflux and persistent hydronephrosis in a collecting system that is not amenable to ureteroneocystotomy.