Ureteric video-assisted tailoring and reimplantation using bladder CO2 insufflation for megaureter

This video demonstrates the technique of pneumovesicoscopy to perform a complex reconstructive procedure for a dilated and elongated ureter. Ureter mobilization and re-implantation is performed laparoscopically, a procedure which requires a high degree of skill in advanced laparoscopic surgery.

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Ureteric video-assisted tailoring and reimplantation using bladder CO2 insufflation for megaureter

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Abstract

This video demonstrates the technique of pneumovesicoscopy to perform a complex reconstructive procedure for a dilated and elongated ureter. Ureter mobilization and re-implantation is performed laparoscopically, a procedure which requires a high degree of skill in advanced laparoscopic surgery.

Media type

Surgical video

Duration

05'05''

Publication

2007-04

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E-publication

WeBSurg.com, Apr 2007;7(04).
URL: http://www.websurg.com/doi-vd01en2111.htm

Ureteric video-assisted tailoring and reimplantation using bladder CO2 insufflation for megaureter

1. Trocar insertion 00'17''

This is the case of a 1-year-old girl who suffered from urinary tract infection and pain due to a right vesicoureteric obstruction. The diameter of the distal ureter was 20mm. The first step of the procedure is an ureterocystoscopy that confirms the stenosis of the right orifice. Three 5mm ports are inserted suprapubically under vesical visual control. You can now see the position of the surgeon, the assistant, the nurse and the anesthesiologist.

2. Ureter mobilization 01'10''

A 5mm scope provides the intravesical vision. The right ureter is progressively dissected with a 3mm monopolar hook. To avoid a tedious intravesical handling, the distal ureter is temporarily extracted through the urethra. About 7 to 10 cm of ureter are mobilized.

3. Extracorporeal ureter refashioning 01'55''

The megadolichoureter is then extracted together with the right port through the bladder and the abdominal wall. Outside of the abdomen, excision of the redundant portion and tailoring are performed using a classical open surgical technique, in that case the Enderin technique. The narrowed segment of the ureter is reintroduced in the bladder together with the port.

4. Uretero-vesical reimplantation 02'40''

The hiatus created during the first step of the procedure in the bladder floor is now repaired using 5/0 absorbable sutures. The submucosal tunnel is fashioned according to the Cohen technique. The ureteral extremity is anchored to the bladder musculature and circumferentially to the mucosal edges of the tunnel.

5. Port closure 04'13''

Lateral port holes are closed using a special suture passer instrument. The bladder catheter is left for 2 days. The median port hole is closed under direct vision. This technique is also appropriate in case of bilateral megaureter.