Abstract
To demonstrate the feasibility of pure robotic retrocaval ureter repair. A 33 year old female presented with right loin pain and obstruction on intravenous urography with the classical "fish-hook" appearance. She was counseled on the various methods of repair and elected to have a robot assisted repair. The following steps are performed during a pure robotic retrocaval ureter repair. The patient is placed in a modified flank position, pneumoperitoneum created and ports inserted. The colon is mobilized to expose the retroperitoneal structures: inferior vena cava, right gonadal vein, right ureter, and duodenum. The renal pelvis and ureter are mobilized and the renal pelvis transected. The ureter is transposed anterior to the inferior vena cava and a pyelopyelostomy is performed over a JJ stent. This patient was discharged on postoperative day 3. The catheter and drain tube were removed on day 1. Her JJ stent was removed at 6 weeks postoperatively. The postoperative intravenous urography at 3 months confirmed normal drainage of contrast medium. Pure robotic retrocaval ureter is a feasible procedure; however, there does not appear to be any great advantage over pure laparoscopy, apart from the ergonomic ease for the surgeon as well the simpler intracorporeal suturing.
Highlights
Retrocaval ureter is an unusual urological SUREOHPWKDWPD\UHTXLUHRSHUDWLYHUHSDLU )LJXUH 7KH¿UVWFDVHRIUHWURFDYDOXUHWHUUHSDLUZDVSXEOLVKHG LQ E\$QGHUVRQ DQG +\QHV 7KH FODVVLFDO approach is an open technique of transposing the ureter anteriorly to the inferior vena cava followed by ureteroureterostomy
We present our robotic technique of pure robotic retrocaval ureter repair
Robotic technology has become incorporated into certain areas of urology as in robotic prostatec tomy and has become well accepted
Summary
Retrocaval ureter is an unusual urological SUREOHPWKDWPD\UHTXLUHRSHUDWLYHUHSDLU )LJXUH 7KH¿UVWFDVHRIUHWURFDYDOXUHWHUUHSDLUZDVSXEOLVKHG LQ E\$QGHUVRQ DQG +\QHV 7KH FODVVLFDO approach is an open technique of transposing the ureter anteriorly to the inferior vena cava followed by ureteroureterostomy. Laparoscopic retrocaval ureter repairs have been performed but can be WHFKQLFDOO\ FKDOOHQJLQJ 7KLV LV WKH ¿UVW FDVH RI D SXUHURERWLFUHSDLUWRRXUNQRZOHGJHSHUIRUPHGLQ an adult. We present our robotic technique of pure robotic retrocaval ureter repair. FUHDWH D SQHXPRSHULWRQHXP WKHQ D PP SRUW LV inserted for the camera at the level of the umbilicus just lateral to the rectus abdominis muscle. VXSHULRULOLDFVSLQHDQGXPELOLFXV $IXUWKHUPP port is inserted 3 cm below the camera port for the assistant to perform retraction and suction. IURP LWV VXUURXQGLQJ IDVFLDO OD\HUV 7KH SUR[LPDO right ureter is dissected free where it can be seen to disappear superiorly under the inferior vena cava
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