A New Laparoscopic Anti-Reflux Ureteral Reimplantation Method

Abstract

Background: Ureteral reimplantation can be performed by a large number of surgical procedures. Almost all of the surgical anti-reflux reimplantation methods are based on the creation of a sub-mucosal tunnel. All of these techniques are very difficult to perform by the laparoscopic approach due to the large number of delicate dissections and intracor-poreal sutures. We evaluated a new ureteroneocystostomy technique which provides a good anti-reflux mechanism and can be easily applied by the laparoscopic approach. We specially adapted this technique to be done by laparoscopy. Materials and Methods: We applied the new ureteroneo-cystostomy technique to a group of 8 pigs with a medium weight of 34 kg. The surgical approach was transperitoneal, using a zero degree laparoscope. A unilateral reimplanta-tion was performed in all cases. The feasibility of the new laparoscopic method was assessed by: the operating time and the time consuming steps of the surgical procedure, the difficult maneuvers, the intra-operative incidents and the post-operative complications. Retrograde cystography was performed 2 weeks later. Six weeks post-operatively we extracted specimens for histopathologic examination. Results: The new method provides a short operative time, aiming for less than 35 min. The new method also excludes time consuming maneuvers and excessive sutures on the new ureterovesical junction. Pathologic examination of the intravesical ureteral segment showed viable junction tissue. Conclusion: The short operating time is a strong argument for the further development and implementation of this method. The technical simplicity and efficacy of this laparoscopic method recommend it as an appropriate alternative to classical ureteroneocystostomy techniques.