V569: Robotic Assisted Laparoscopic Ipsilateral Ureteroureterostomy to Manage an Ectopic Ureter in a Pediatic Patient

Video

Introduction and Objectives
Ipsilateral ureteroureterostomy has been used to treat duplication anomalies of the urinary tract in the pediatric patient. Our objective is to demonstrate the techniques used in robotic surgical management of an ectopic ureter.

Methods
An 8 year-old female presented to our pediatric urology clinic with complaints of persistent day and night time incontinence. Her exam was notable for perineal excoriation from being persistently damp. Cystoscopy and bilateral retrograde pyelograms demonstrated a complete duplication of her right collecting system. The lower pole empties into her bladder in an orthotopic position. The upper pole ureter was found to enter the distal uretha. A robotic assisted laparoscopic ipsilateral ureteroureterostomy was performed. A ureteral stent was placed prior to the robotic portion of the procedure. Four ports were placed (three robotic ports and one assistant port). The ureters were identified as they coursed along the psoas muscle. They were dissected free from surrounding attachments. Traction sutures were placed within the upper pole ureter for manipulation. The upper pole ureter was divided and spatulated. A 2 cm ureterotomy was made in the lower pole ureter. The anastomosis was performed using 5-0 monocryl suture in the running fashion. The distal ectopic ureter was ligated at the level of the trigone and excised. A 7 mm round Jackson Pratt drain was left in place.

Results
The surgery was uncomplicated. The patient was discharged home on postoperative day 2 after an uneventful hospital stay. She was dry immediately after surgery. She continues to do well and is dry at 1 year of follow-up.

Conclusions
Robotic surgical techniques can be successfully applied to management of ectopic ureter in a pediatric patient. Robotic assisted laparoscopic ipsilateral ureteroureterostomy is a minimally invasive surgery that has no need for bladder reconstruction, thus reducing post-operative bladder symptoms such as urge, frequency and spasms.

Funding: none