V01-04 SINGLE-PORT ROBOTIC EXTRAPERITONEAL RIGHT URETERAL REIMPLANTATION WITH BOARI FLAP

Abstract

You have accessJournal of UrologyCME1 Apr 2023V01-04 SINGLE-PORT ROBOTIC EXTRAPERITONEAL RIGHT URETERAL REIMPLANTATION WITH BOARI FLAP Melissa Moran, Alain Kaldany, Krishna Doppalapudi, Arnav Srivastava, and Sammy Elsamra Melissa MoranMelissa Moran More articles by this author , Alain KaldanyAlain Kaldany More articles by this author , Krishna DoppalapudiKrishna Doppalapudi More articles by this author , Arnav SrivastavaArnav Srivastava More articles by this author , and Sammy ElsamraSammy Elsamra More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003221.04AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Patients with multiple abdominal surgeries often harbor hostile abdomens with significant bowel adhesions. It is thus difficult to obtain safe transperitoneal access when placing robotic trocars. An extraperitoneal approach, in contrast, allows for safe entry into the abdomen. In the case of a mid to distal ureteral stricture requiring extraperitoneal Boari flap ureteral reimplantation, the conventional multiport approach would be suboptimal as arm spacing would be insufficient. Here we demonstrate our surgical technique and the feasibility of a single port (SP) extraperitoneal Boari flap ureteral reimplantation. METHODS: A 70-year-old female with a history of rectal cancer treated with multiple abdominal surgeries and chemoradiation was diagnosed with a distal right ureteral stricture. She was offered SP robotic ureteral reimplantation for definitive management. The patient was positioned in steep Trendelenburg with a left-sided tilt. A 4 centimeter (cm) incision was created over the right lateral aspect of the abdomen 8 cm above the anterior superior iliac spine, and the retroperitoneal space was entered. The SP access port was placed and the robot was docked. The ureter was identified crossing the iliac vessels and was dissected proximally and distally. Once scar tissue was encountered, the ureter was transected. The bladder was mobilized and the medial umbilical ligament was cut. The distance from the ureter to the bladder was measured, and a Boari flap of this length was created. The posterior ureter was then spatulated and a Boari flap anastomosis was performed. The bladder was closed in a Heineke-Mikulicz fashion and a double-J ureteral stent was placed in the right ureter. The bladder was distended to ensure a watertight closure. A drain was placed and the Foley catheter was exchanged. RESULTS: The operative time was roughly three hours, with 50 milliliters of estimated blood loss. On post-operative day one, the drain was removed and patient was discharged home. Imaging two weeks later showed improved hydronephrosis with no urine extravasation, and the Foley catheter was removed. The ureteral stent was removed at four weeks post-operatively. Ultrasound and renal scan three months later demonstrated improved hydronephrosis with preserved renal function and no evidence of obstruction. CONCLUSIONS: To our knowledge, this is the first video demonstrating an SP extraperitoneal Boari flap ureteral reimplantation. This approach is feasible and allows a surgeon to safely and effectively perform a primarily retroperitoneal procedure without entering a hostile abdomen. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e80 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Melissa Moran More articles by this author Alain Kaldany More articles by this author Krishna Doppalapudi More articles by this author Arnav Srivastava More articles by this author Sammy Elsamra More articles by this author Expand All Advertisement PDF downloadLoading ...