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ROBOTIC URETERO-URETEROSTOMY: A BETTER SOLUTION FOR UPPER POLE
OBSTRUCTION
Dana WEISS, Christopher LONG, Arun SRINIVASAN and Aseem SHUKLA
The Children's Hospital of Philadelphia, Pediatric Urology, Philadelphia, USA
PURPOSE
Robotic-assisted laparoscopy (RAL) has been rapidly adopted in pediatric urology due to favorable outcomes coupled
with the benefits of improved visualization, facile instrumentation and short hospital stay. RAL has provided safe and
effective approaches to lower tract reconstruction which may obviate the need for more risky upper pole approaches in
cases of upper pole ureteral ectopia or obstruction. We present the basic steps for a robotic assisted laparoscopic upper
to lower pole ureteroureterostomy.
MATERIAL AND METHODS
The patient is positioned in the dorsal lithotomy position for the entire procedure. Cystoscopy is performed for
placement of a double J stent into the normal lower pole ureter. Peritoneal access is obtained and ports are placed in
the same orientation as for an extravesical ureteral reimplantation. The upper and lower pole ureters are identified and
separated, and the upper pole ureter is transected. The remaining distal ureter is excised. Using a hitch stitch to
stabilize it, a longitudinal incision is made into the lower pole ureter and an end to side anastomosis is performed.
RESULTS
Robotic assisted laparoscopic ureteroureterostomy avoids manipulation of the bladder, avoids the risk of renal loss from
upper pole partial nephrectomy, and enables visualization of the entire length of the ureter which is important for cases
of long distal obstruction.
CONCLUSIONS
By virtue of a wide field of vision and facile instrumentation, RAL ureteroureterostomy provides a valuable alternative to
the management of upper pole ectopic or obstructed ureters, and avoids potentially morbid or risky procedures involving
the bladder or kidney.