Presentation Authors: Amos Neheman*, Jonathan Gal, Leon CHERTIN, Tzrifin, Israel, Jaudat Gaber, Stanislav Kocherov, Jerusalem, Israel, Amnon Zisman, Tzrifin, Israel, Paul Noh, Cincinnati, OH, Boris Chertin, Jerusalem, Israel
Introduction: In this video we describe a technique of robot assisted extravesical cross-trigonal ureteral re-implantation with intra-corporal tailoring of the ureter.
Methods: We present a multi institutional study of 20 cases, in this video we describe the case of a 1y/o male who was diagnosed with a left mega-ureter prenatally. US scans showed dilation of renal pelvis and ureter (17mm), MAG3 Renal scan indicated 37% function of the left kidney with delayed drainage.The patient was placed in the supine position. A Foley catheter was inserted to allow bladder distention. Peritoneal access is obtained with the open Hasson technique. 12mm camera port at the umbilicus, 2 robotic 8mm ports and an assistant 5-10mm ports were placed under vision. The distal ureter was identified and dissected distally to the bladder were it is ligated and transected. Ureteral tailoring was performed over a 7FR UK and sutured with a 3-0 V-Locâ„¢. A transverse trough of 4-5cm is created. Emphasis is made to dissect the detrusor to facilitate a tension free closure over the ureter. Bladder mucosa Is opened and uretero-vesical anastomosis is performed with interrupted 5-0 PDS sutures over DJ stent. Detrusor tunnel is closed incorporating the ureter between the mucosa and the detrusor. Water tight closer is verified.
Results: Console time was 180 min. Patient was discharged on POD1, DJ stent was removed 4 weeks post operatively. Imaging showed improvement in hydronephrosis and renal drainage.
Conclusions: Robot assisted cross-trigonal ureteral re-implantation with intracorporeal tailoring is safe feasible and reproducible.