Single-incision multiport laparoendoscopic technique to repair retrocaval ureter using the Santosh PGI ureteric tacking fixation technique

Introduction: A retrocaval ureter is a rare congenital anomaly associated with upper urinary tract obstruction. It can cause varying degrees of ureteral obstruction, and surgical intervention is often necessary. Here, we present a case of a retrocaval ureter repaired with the single-incision multiport laparoendoscopic technique. We used a new fixation technique, Santosh PGI (Postgraduate Institute) ureteric tacking fixation technique, on both ureteric ends for easy ureteroureteric anastomosis.

Materials and surgical technique: A 45-year-old man presented with right loin pain. CT urography showed a retrocaval ureter. Because the patient was symptomatic, he underwent retrocaval ureter repair by the single-incision multiport laparoendoscopic technique. A double-J stent was placed in the right ureter with the patient in the lithotomy position. Then, the patient was placed in a modified flank position. After pneumoperitoneum was created, a 2.5-cm incision was made in the umbilicus, and three conventional laparoscopic ports were inserted. The narrow retrocaval segment of ureter was resected, and both spatulated ureteric ends were fixed using the Santosh PGI ureteric tacking fixation technique, and ureteroureteral anastamosis was done. The duration of the procedure was 105 min. The patient was discharged from the hospital on postoperative day 3. Follow-up intravenous pyelography at 3 months showed normal drainage.

Discussion: The single-incision multiport laparoendoscopic technique is feasible and cost effective, has good cosmesis, and has minimal morbidity when performed by an expert laparoscopic surgeon. The Santosh PGI ureteric tacking fixation technique enabled us to suture easily and rapidly within the limited range of motion allowed by conventional laparoscopic instruments in SILS.