V873: Robotic Management of Obstructed Retrocaval Ureter
VideoIntroduction and Objectives
Retrocaval ureter is a rare congenital anomaly that usually presents in the third or fourth decade with symptoms of obstruction from external compression by the inferior vena cava. Our objective is to demonstrate robotic surgical management of an obstructed retrocaval ureter.
A 40-year-old male with known right retrocaval ureter underwent percutaneous nephrolithotomy for a staghorn calculus in the ipsilateral kidney. Postoperative computed tomography reconfirmed hydroureteronephrosis to the level of L3 where the ureter deviated medially behind the inferior vena cava. The patient returned after several weeks for robot assisted laparoscopic ureteroureterostomy. An open ended ureteral stent was placed cystoscopically before robotic repair was performed. Four ports (two 12 mm and two 8mm) were placed and triangulated to the point of obstruction. Using a transperitoneal approach, the proximal ureter was dissected to the point at which it coursed posterior to the vena cava. From inferiorly, the dissection was carried to a point distal to the site at which the ureter emerged from behind the vena cava. After transecting and spatulating both segments of the ureter, a stented ureteroureterostomy was performed. The retrocaval portion of the ureter was left in place. A drain was brought through the inferior port site.
The procedures (cystoscopy and robotic ureteroureterostomy) took 262 minutes. Estimated blood loss was 50mL. The patient was discharged home on postoperative day 2 after the drain and Foley were removed.
Robotic surgical techniques can be successfully applied to challenging genitourinary conditions such as a retrocaval ureter.