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S28-9
(P)
LAPAROSCOPIC EXTRAVESICAL URETERAL RE-IMPLANTATION: REFINEMENT OF
THE TECHNIQUE
John-Paul CAPOLICCHIO, Talal AL-QAOUD , Hiba ABOU-HAIDAR , Roman JEDNAK, Alex BRZEZINSKI and Mohamed EL-
SHERBINY
McGill University, Department of Paediatric Surgery, Division of Paediatric Urology, Montreal, CANADA
INTRODUCTION
Our current technique of laparoscopic ureteral reimplantation has evolved with the addition of 3D vision endoscopy,
bipolar cautery and a 3 port approach. We evaluated the benefit of the current 3D technique by comparing it to a
previous cohort of 2D laparoscopy
PATIENTS AND METHODS
A retrospective review of 19 children who underwent laparoscopic extravesical ureteral reimplantation by a single
surgeon from 2005 to 2013 was performed. The current 3D (11 patients) cohort was compared to the previous 2D (8
patients) cohort, excluding cases from 2002-2005 to account for the learning curve. Descriptive data, grade of VUR,
dimension, technique of detrusor tunnel mucosal dissection, tunnel length, operative time, length of stay, and
complications were retrieved. All statistical analysis was conducted per ureter (total of 28 ureters operated)
RESULTS
The median age of all patients was 5yrs, with the distribution of grades of VUR from 1 to 5 being 1-9-8-10-0, with 4
cases of common sheath reimplantation. The mean operative time for 2D (12 ureters) and 3D (16 ureters) was 217min
and 130min. operative time was reduced by an average of 86 minutes per ureter with the use of 3D laparoscopy vs. 2D
(p<0.01), and mucosal perforation rate was decreased from 67% to 19% (p=0.01). There was no statistically significant
difference between the 2 groups in the number of bilateral cases, median age or weight, mean detrusor tunnel length,
nor grade of reflux. The 3D group was different in that the bipolar hook was used in 7 cases and 3 ports were used
instead of 4. 3D laparoscopy did not significantly impact in-hospital stay
CONCLUSIONS
Operative times and mucosal perforation rates are significantly reduced with the use of 3D vision endoscopy and the
bipolar hook for extravesical ureteral reimplantation. The 3D approach provides a novel alternative to which robotic
assisted techniques should be more critically evaluated