V1719: Robotic-Assisted Laparoscopic Transplant to Native Ureteroureterostomy
VideoIntroduction and Objectives
A 14 year old girl with Fanconi’s syndrome five years post-kidney transplant for end-stage renal disease secondary to cystinosis presented to the pediatric urology clinic with the diagnosis of a transplant ureteral stricture involving two-thirds of her ureter with resulting hydronephrosis and elevated creatinine. We present a novel minimally-invasive surgical approach to a late transplant ureteral stricture.
Using a three-port technique with 8 millimeter instruments, we performed a robotic-assisted laparoscopic transplant-to-native ureteroureterostomy with ureteral stent placement across the anastomosis.
There were no intraoperative complications and blood loss was minimal. In the immediate post-operative period, the patient experienced a urine leak requiring an additional stent to the transplant kidney via the transplant ureter. The stents were removed and her hydronephrosis progressively decreased on ultrasound to stable mild upper pole pelviectasis with 10 month follow-up. Her creatinine stabilized at a baseline of 0.9 mg/dl.
Robotic assisted laparoscopic transplant-to-native ureteroureterostomy is a technically feasible procedure. Improvement on this procedure would be to employ maximal drainage by use of a larger caliber stent if possible.