IPEG 2020 TOP ABSTRACT: Robotic Surgery for Iatrogenic Ureterovesical Stenosis
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Patient was a 3-year-old boy followed for antenatal hydronephrosis who had undergone 2 subureteric injections at another center for vesicoureteral reflux.
Severe right ureterovesical stenosis was detected on MR urography in a child with recurrent urinary tract infections.
Right kidney function was 11% on DMSA scan preoperatively.
In robotic surgery for this case, the camera trocar was placed approximately 3 cm above the umbilicus in the midline, unlike conventional laparoscopic surgery.
Right and left 8 mm robotic working ports were placed where the umbilicus level and the anterior axillary line cross.
A 10 mm assistant trocar was placed between the camera trocar and the left robotic trocar.
Severe right ureteral dilatation was observed intraoperatively.
The ureterovesical junction was found to be extremely fibrotic and stenotic.
Previously performed injection materials were cleaned from the ureterovesical junction area.
After transecting the ureterovesical junction, no leakage was observed from the filled bladder.
The serotomy line for ureteral tapering was marked at 4 cm in length.
The ureter was fixed to the abdominal wall to facilitate the tapering process.
Ureteral tapering was performed rapidly and comfortably due to unique advantages of robotic arms.
Ureteral reimplantation was performed in continuous fashion with 5-0 Vicryl suture.
A double-J catheter was inserted when the posterior ureterovesical anastomosis was completed.
The anterior anastomosis was performed in continuous fashion with 4-0 suture.
Leakage control was performed with saline and no leakage was observed.
The patient was discharged on postoperative day 8.
During the follow-up period, no urinary infection was observed.
Right renal function improved from 11% preoperatively to 16% on DMSA at 2-year follow-up.