Robotic Intracorporeal Tailoring and Reimplantation of Megaureter

Abstract

Introduction:

Primary obstructive megaureter is characterized by an intrinsic congenital obstruction at the lower 1–2 cm of the ureter just before it enters the bladder. In adults it can become symptomatic and cause pain or recurrent urinary infection. We present our experience in managing megaureter and performing intracorporeal tailoring and reimplantation in adults using robotic assistance. ¹

Methods:

A daVinci S Surgical system is used for this procedure. The camera is placed supraumbilically. The ipsilateral robotic arm is placed approximately 2.5 cm lateral to the rectus sheath and 3 cm caudal to the camera. The contralateral robotic arm is inserted along the rectus sheath 3 cm caudal to the camera port. The fourth arm is placed through an 8-mm port 5 cm cranial to the iliac crest on the contralateral side. A 5-mm assistant port is located 5 cm cranial to the ipsilateral iliac crest. To bring sutures into the field, a robotic instrument is removed and sutures are placed through the robotic port, so the only assistance needed is a 5-cm port. The dilated ureter can typically be seen peristalsing through the peritoneum. The peritoneum is opened and the distal ureter is dissected to the ureterovesical junction. Retrograde intracorporeal Double-J stenting is performed at this time. Through the assistant 5-mm port, an 8F ureteral stent is inserted. This is a pre-prepared Double-J stent mounted over the guidewire and placed through the 5-mm port. A 5-0 Monocryl suture is used to reconstruct the distal ureter over the stent. A vesicostomy is performed along the anterior insertion of the ureter. The distal ureter is kept attached to the bladder posteriorly and can be used as a bucket handle for manipulation of the ureterovesical junction during the anastomosis. Primary anastomosis of the ureter to the bladder is then performed using a 5-0 Monocryl.

Results and Conclusions:

Using these techniques, we have performed this procedure in five patients. The video details tips for successful surgical repair.

No competing financial interests exist.

Runtime of video: 4 min 55 sec