V908: Technique of Robot-assisted Transperitoneal Ureteroureterostomy for Retrocaval Ureter Repair
VideoIntroduction and Objectives
Retrocaval ureter is a rare entity that can lead to chronic obstructive symptoms as well as recurrent infections. Traditional surgical repair for this condition has been from an open approach, and limited reports of laparoscopic procedures have been described. Given the improved dexterity and visualization of robot-assisted laparoscopy as well as increasing experience with robotic renal and ureteral surgery, there is a potential to utilize this technology for more advanced reconstructive procedures. We now present the first complete report with accompanying video of a patient undergoing a robot-assisted transperitoneal ureteroureterostomy for repair of a retrocaval ureter.
A 47 year-old woman with longstanding right flank pain and recurrent pyelonephritis was diagnosed with a retrocaval ureter via CT scan. Retrograde pyelogram demonstrated a tortuous right ureter with delayed drainage of contrast proximal to the retrocaval portion. A double-J ureteral stent was placed with subsequent partial relief of pain. The decision was made to undergo definitive surgical repair.
A standard medial camera port placement template was utilized in a fashion similar to routine robotic renal and ureteral procedures. Transperitoneal ureteroureterostomy was successfully performed with a fully robot-assisted approach as shown in this video. The operative time was 122 minutes. Estimated blood loss was 50cc. There were no intraoperative complications.
This video demonstration illustrates that robot-assisted transperitoneal ureteroureterostomy for retrocaval ureter repair can be done safely and efficiently. This procedure is a feasible approach for surgeons experienced with robotic renal and ureteral operations and demonstrates the potential for advanced reconstructive urological surgery using robot-assisted laparoscopy.