Congreso AUA 15-23 de Mayo

domingo, 3 de junio de 2012

Hace escasos días se ha celebrado el Congreso de la AUA en Atlanta. De entre nosotros han acudido, por lo menos, los Drs. I Hernáez, A Astobieta y Javier Estébanez quien ha presentado el siguiente vídeo.



V1031
ROBOTIC-ASSISTED LAPAROSCOPIC URETERAL REIMPLANTATION WITH PSOAS HITCH
Javier Estébanez*, Adolfo Cátedra, Gregorio Garmendia, Cristina Garrido, Itziar Crespo, Miguel Gutierrez, Ione Linazasoro, Jon
Belloso, Enrique Artozki, Juan Sanz, San Sebastian-Donostia.
INTRODUCTION AND OBJECTIVES: We present our initial experience in robotic-assisted laparoscopic ureteral
reimplantation with psoas hitch
METHODS: In this case-study, a 50 year old female patient has been diagnosed with ureteral stenosis after having a
hysterectomy. We position the patient supine with a slight trendelenubrg tilt. The camera port is placed 2 cm superior to the
umbilicus with two robotic trocars placed laterally. An assistant port is placed in the iliac fossa. We start the procedure with an
incision in the posterior parietal peritoneum. We locate the ureter and dissect it at the point of the stenosis. The ureter is clipped and
divided. We dissect the anterior and lateral walls of the bladder, ensuring that it can later be anchored to the psoas muscle. The
ureter is spatulated. A double J stent is inserted into the ureter through the assistant trocar. We hitch the bladder to the psoas using
3 polyglactin (teen) sutures. An incision is made in the muscular layer of the selected area of the bladder, sparing the mucosa. The
superior sutures must include all of the layers of the bladder and ureteral walls. The inferior and lateral sutures must only include the
ureter and the bladder mucosa. We complete the reimplantation with several sutures in the bladder muscle, enclosing the ureter
between the muscular layer and the mucosa. A drain tube is placed.
RESULTS: In this case, surgical time was 100 minutes and the hospital stay 4 days. No intra or post-operative
complication occurred.
CONCLUSIONS: Robotic-assisted laparoscopic ureteral reimplantation with psoas hitc is a feasible and reproducible
procedure

Casos Clínicos

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