Abstract
Introduction and Objective:
Ureterocalicostomy can be performed for reconstruction of complicated proximal ureteral strictures. In this video, we present a case of proximal ureteral stricture with intrarenal pelvis and dependent lower pole calix associated with recurrent nephrolithiasis repaired with robot-assisted laparoscopic ureterocalicostomy.
Methods:
The patient was placed in the right lateral decubitus position, robotic ports were inserted, and the da Vinci Xi robot was docked. After bowel mobilization, the ureter was identified, and the renal hilum was dissected. The proximal stricture and intrarenal pelvis were then observed. Intraoperative ultrasonography aided in identifying the location of the lower pole for the partial nephrectomy. At this point, the renal artery was clamped, and a lower pole wedge resection was performed. The clamps were removed after oversewing the parenchyma. Next, a 16-F flexible cystoscope was inserted through the assistant port into the collecting system for stone basket extraction.The ureter, which was incised at the ureteropelvic junction, was posteriorly spatulated for 3 cm and reanastomosed to the lower calix. A stent was inserted, and the integrity of the anastomosis was verified by backfilling the bladder with methylene blue solution. To conclude, the anastomosis was protected with a Gerota's flap.
Results:
The length of the operation was 4.5 h. Estimated blood loss was 50 mL and no complications were reported. On the first postoperative day, computed tomography showed decreased stone burden. The patient was discharged home after drain removal. At 6-week follow-up, ureteroscopy and retrograde pyelography exhibited no evidence of obstruction at the anastomotic site.
Conclusions:
This video features key components of robot-assisted laparoscopic ureterocalicostomy, which can safely and effectively repair proximal ureteral strictures in the setting of intrarenal pelvis and dependent lower pole calix.
Author(s) have received and archived patient consent for video recording/publication in advance of video recording of procedure.
Runtime of video: 6 mins 28 secs
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