V861 LAPAROSCOPIC TRANSVESICAL URETERIC RESECTION AND RE-IMPLANTION

Abstract

You have accessJournal of UrologyReconstruction, Transitional Cell Carcinoma & Adrenal1 Apr 2011V861 LAPAROSCOPIC TRANSVESICAL URETERIC RESECTION AND RE-IMPLANTION Philippe Grange, Amrith Rao, Davinder Sharma, Christian Brown, and Angelika Zang Philippe GrangePhilippe Grange London, United Kingdom More articles by this author , Amrith RaoAmrith Rao London, United Kingdom More articles by this author , Davinder SharmaDavinder Sharma London, United Kingdom More articles by this author , Christian BrownChristian Brown London, United Kingdom More articles by this author , and Angelika ZangAngelika Zang London, United Kingdom More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.683AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Segmental excision and ureteric re-implantation is an accepted surgical option for benign stricture or localised transitional cell carcinoma (TCC) affecting the lower 1/3rd of the ureter. Most often, the operation is performed by an open approach, but increasingly laparoscopic approach is favoured because of the obvious advantages. One of the difficulties with the laparoscopic approach is dealing with the ureteric orifice & the intra-mural part of the ureter. Although we have performed this technique for benign ureteric strictures, this particular video is about a 62 year old lady with recurrent high-grade superficial TCC in the right lower ureter. With this high definition video, we demonstrate a transvesical laparoscopic lower ureteric excision and re-implantation. METHODS With the patient in lithotomy position, ureteroscopy is performed to look at the length that requires excision. Cystoscopic dismembering of the intramural ureter is carried out upto the perivesical fat using a Collin's knife. The bladder is then distended using the gas insufflation connected to the urethral catheter. A 10 mm VisiportTM along with the camera allows access to the bladder under direct vision. Further two 5 mm ports were inserted under the camera guidance. Bladder was also suspended using two percutaneous stitches, which allowed sufficient working space. Entire operation was performed with gas insufflation of the bladder. Ureter is mobilized further till the desired length of excision. A neo-orifice is created distally and the ureter is brought through this opening into the bladder. The site of the old ureteric orifice is then closed. The diseased distal segment is useful to manipulate the ureter and spatulation is carried out. The ureter is then anchored to the neo-orifice using interrupted sutures. The diseased segment is excised and retrieved urethrally. The guide-wire is passed via the urethra and directed into the ureter. JJ stent is subsequently inserted. RESULTS The total operative time was 180 minutes with blood loss < 50 mL. There were no intra- or post-operative complications. The in-hospital stay was 3 days. The patient was discharged home with a urethral catheter on free drainage, which was removed in 2 weeks after cystogram showing no evidence of leak. At the last follow-up ureteroscopy and multiple biospies, there was no evidence of stricture or disease recurrence. CONCLUSIONS We demonstrate in this video our technique of transvesical laparoscopic excision and ureteric re-implantation. We demonstrate that the short-term functional and oncological outcome is equivalent to the established open approach. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e345 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Philippe Grange London, United Kingdom More articles by this author Amrith Rao London, United Kingdom More articles by this author Davinder Sharma London, United Kingdom More articles by this author Christian Brown London, United Kingdom More articles by this author Angelika Zang London, United Kingdom More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...