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Urology. 2019 Dec;134:243-245. doi: 10.1016/j.urology.2019.09.003. Epub 2019 Sep 19.

Robot-assisted Laparoscopic Extravesical Cross-trigonal Ureteral Reimplantation With Tailoring for Primary Obstructive Megaureter.

Author information

1
Department of Urology, Shamir Medical Center (Assaf Harofeh), Zerifin, Israel, Affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
2
Department of Urology, Shamir Medical Center (Assaf Harofeh), Zerifin, Israel, Affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel. Electronic address: AndrewDavidShumaker@gmail.com.
3
Cincinnati Childrens' Hospital Medical Center, Division of Pediatric Urology, Cincinnati, OH.
4
Departments of Urology and Pediatric Urology, Shaare Zedek Medical Center, Faculty of Medicine, Hebrew University, Jerusalem, Israel.

Abstract

OBJECTIVE:

To describe a novel, minimally invasive surgical technique, robotic-assisted laparoscopic dismembered extravesical cross-trigonal ureteral reimplantation for primary obstructive megaureter and to report a case series of 13 patients.

METHODS:

Thirteen patients between the ages of 10 and 96 months who were diagnosed with primary obstructive megaureter underwent robotic-assisted laparoscopic dismembered extravesical cross-trigonal ureteral reimplantation between April 2017 and May 2019. The principle of this technique is performing an extravesical cross-trigonal ureteral reimplantation with intracorporeal tailoring of the ureter. This provides the advantage of achieving a long tunnel mimicking the Cohen cross-trigonal ureteral reimplantation, without performing the open surgical technique and offers the potential benefits of minimally invasive surgery. Surgical technique is described, demographic data and intra- and/or postoperative parameters are reported.

RESULTS:

Median age was 26 months (IQR 16-60). Median weight was 15 kg (IQR 10.1-31). Median console time was 113 minutes (IQR 90.5-140). Median postoperative stay was 2.5 days (IQR 1.3-3). Median ureteral diameter decreased from 17 mm (IQR 12.5-18.5) to 3 mm (IQR 0-6.5, P = .001). Median renal pelvis diameter decreased from 28 mm (IQR 20.5-37.8) to 4 mm (IQR 1.5-5, P = .005). Median renal function before surgery was 46% (IQR 24.5-48.5) and following surgery was 42% (IQR 36-42, P = .700). Median T1/2 decreased from 28 minutes (IQR 19.3-30) to 4.5 minutes (IQR 3-5, P = .009). Postoperative complications graded by the Clavien-Dindo classification were apparent in 3 patients (21%). One had grade I complication (fever, resolved spontaneously) and 2 had a Grade II complication (urinary tract infection).

CONCLUSION:

Robot-assisted cross-trigonal ureteral reimplantation with intracorporeal tailoring is safe, feasible, and reproducible in short-term follow-up.

PMID:
31542465
DOI:
10.1016/j.urology.2019.09.003
[Indexed for MEDLINE]

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