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VR-29
(VS)
PEDIATRIC ROBOTIC-ASSISTED LAPAROSCOPIC URETEROCALICOSTOMY: TIPS
AND TRICKS
Mohan GUNDETI
1
and David HATCHER
2
1) The University of Chicago Medicine, Surgery - Section of Pediatric Urology, Chicago, USA - 2) The University of
Chicago Medicine, Surgery - Section of Urology, Chicago, USA
PURPOSE
Robotic-assisted laparoscopic ureterocalicostomy is a treatment option for patients with recurrent ureteropelvic junction
(UPJ) obstruction after failed pyeloplasty. We present the role of flexible pyeloscopy and the harmonic scalpel in
identification of the dependent lower pole renal calyx and in maintaining a hemostatic anastomosis, especially in those
with a thick renal cortex.
MATERIAL AND METHODS
In this case, our patient was a 4 year-old female with a right UPJ obstruction who had failed prior pyeloplasties with
increasing hydronephrosis and recurrent urinary tract infections.
The patient was placed in the left lateral decubitus position, and a transperitoneal approach was employed. The colon
was reflected, and the right ureter and hydronephrotic kidney were identified. The ureter was spatulated before
transection, to take advantage of two fixed points. A flexible cystoscope was inserted through the transected UPJ via the
assistant port to identify the most dependent lower pole calyx, which was then amputated with harmonic shears to
expose the calyx with bloodless edges. The proximal ureteral stent was placed into the lower pole through this opening.
Interrupted sutures were placed from the calyceal epithelium to the spatulated ureter at 3, 6, 9, and 12 o’clock and then
tied simultaneously to prevent tearing. A hemostatic agent was applied to the surgical site, and a drain was placed.
RESULTS
The procedure was uneventful without intraoperative or perioperative complications. The ureteral stent was removed at
four weeks, and postoperative ultrasound showed improvement of her hydronephrosis.
CONCLUSIONS
Flexible pyeloscopy and the harmonic scalpel aid in identification of the dependent lower pole calyx and maintain a
bloodless field, especially with a thick renal cortex, for anastomosis in robotic-assisted laparoscopic ureterocalicostomy.