V1031: ROBOTIC-ASSISTED LAPAROSCOPIC URETERAL REIMPLANTATION WITH PSOAS HITCH
VideoIntroduction and Objectives
We present our initial experience in robotic-assisted laparoscopic ureteral reimplantation with psoas hitch
In this case-study, a 50 year old female patient has been diagnosed with ureteral stenosis after having a hysterectomy. We position the patient supine with a slight trendelenubrg tilt. The camera port is placed 2 cm superior to the umbilicus with two robotic trocars placed laterally. An assistant port is placed in the iliac fossa. We start the procedure with an incision in the posterior parietal peritoneum. We locate the ureter and dissect it at the point of the stenosis. The ureter is clipped and divided. We dissect the anterior and lateral walls of the bladder, ensuring that it can later be anchored to the psoas muscle. The ureter is spatulated. A double J stent is inserted into the ureter through the assistant trocar. We hitch the bladder to the psoas using 3 polyglactin (teen) sutures. An incision is made in the muscular layer of the selected area of the bladder, sparing the mucosa. The superior sutures must include all of the layers of the bladder and ureteral walls. The inferior and lateral sutures must only include the ureter and the bladder mucosa. We complete the reimplantation with several sutures in the bladder muscle, enclosing the ureter between the muscular layer and the mucosa. A drain tube is placed.
In this case, surgical time was 100 minutes and the hospital stay 4 days. No intra or post-operative complication occurred.
Robotic-assisted laparoscopic ureteral reimplantation with psoas hitc is a feasible and reproducible procedure