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VR-36
(VS)
THE "RETURN MANOEUVRE" IN PAEDIATRIC ROBOTIC ASSISTED LAPAROSCOPIC
PYELOPLASTY: EASY FOR THE SURGEON, BETTER FOR THE PATIENT
Alexis ARNAUD
1
, Quentin ALIMI
1
, Eric WODEY
2
and Benjamin FRÉMOND
1
1) University Hospital, Paediatric Surgery Department, Rennes, FRANCE - 2) University Hospital, Paediatric
Anesthesiology Department, Rennes, FRANCE
PURPOSE
Literature reports double J stent placements in paediatric robotic assisted laparoscopic pyeloplasty (PRALP). Their main
drawback is the need for either endoscopic removal under general anaesthetic or removal using an uncomfortable
externalized string. We used a novel approach to drain the pelvic cavity.
MATERIAL AND METHODS
Once the posterior wall of the anastomosis was performed, a 14G cathlon was inserted under vision through the
ipsilateral flank wall. A 4.7F Urosoft multipurpose® stent (Bard®), cut after the first loop, was pushed in the abdominal
cavity through the cathlon. Using the needle holder, the inserter was pushed in a calyx and through the parenchyma.
The loop was placed in the renal pelvis and the inserter was pushed back out through the cathlon. The stent was
stitched to the skin. Anastomosis was ended. The stent was clamped two days after surgery and removed two weeks
later in outpatient clinic without sedation.
We present our series of patients who underwent the return technique. Data are given in median (range).
RESULTS
Six patients underwent this technique. Age was 5years (8months-11years). All but one had their stent clamped at day
2. One patient required intermittent clamping during 2 weeks due to intermittent pain. Stent removal was performed in
outpatient clinic at 16 days postoperative for 5 patients and 28 days for one. None presented complication linked to the
stent.
CONCLUSIONS
The "return manoeuvre" is an easy and feasible technique of drainage insertion during PRALP. It avoids the drawbacks
of double J stenting.