Right sided robot assisted ureter reimplantation with Boari flap

Czech version

Authors: Jan Schraml ¹; Milan Hora ^1,2; Martin Hlavička ¹; Marek Broul ¹
Authors‘ workplace: Klinika urologie a robotické chirurgie, Masarykova nemocnice, o. z., KZ, a. s., Univerzita Jana Evangelisty Purkyně, Ústí nad Labem ¹; Urologická klinika LF UK a FN Plzeň ²
Published in: Ces Urol 2020; 24(4): 244-246
Category: Video

Overview

Schraml J, Hora M, Hlavička M, Broul M. Right sided robot assisted ureter reimplantation with Boari flap.

Introduction: Surgical treatment of an iatrogenic lesion of the distal ureter using reimplan‑ tation eventually including a Boari urinary bladder flap was performed openly or, more recently, laparoscopically. Robotically assisted laparoscopy seems to be the optimal choice for simplifying the mini-invasive design. This video presents a robotic reimplantation of the ureter with a Boari flap.

File: In the period from 1/2019 to 6/2020, there were 10 of these surgeries (all iatrogenic lesions of ureter during pelvic surgery) at the department of the main author. All done without the need for conversion. The 4-arm daVinci Xi system is used.

Case report: A 70 year old woman after iatro‑ genic injury of the right ureter during laparoscopic hysterectomy with adnexectomy. Postoperatively right side flank pain, and an ultrasound showed a right sided megaureter. The finding was resolved by puncture nephrostomy and reimplantation per‑ formed 3 months later. Trendelenburg position 20°, 4 robotic ports 8 mm and assistant port 12 mm. Tools 30° camera, Prograsp forceps, Maryland bi‑ polar forceps, Monopolar curved scissors, Large suture-Cut Needle Driver. Surgical adhesions were freed up, right ureter dissected and cut above the lesion. On the filled bladder created a lobe from the right bladder on the right. Without antireflux technique, an anastomosis of an unspatulated ureter with a bladder lobe was performed on an inserted double loop ureteral stent with individual 5-0 polyglactin sutures. The defect of the urinary bladder was closed with running self-anchoring poliglecaprone 25 suture. Operation duration – general anaesthesia 115 min, console time 60 min. Discharged on the 9th postoperative day. Urinary catheter removed in 14 days, stent in 4 weeks. Regular ultrasonographic examinations are without dilatation of the upper urinary tract of the right kidney for 3 months.

Conclusion: Robotic reimplantation of the ureter or even with a flap from the urinary bladder is the preferred method of our department. It completely replaced the open, significantly more invasive approach. Laparoscopy is considered by the authors to be technically significantly more difficult and they have no experience with it.