以膀胱鏡輔助腹腔鏡輸尿管膀胱重接手術
許智凱、張廷瑞、陳世亮
台南市立醫院 泌尿科
Cystoscopy assisted LPS Ureteroneocystostomy for lower ureter stenosis
- A novel technique
Chih-Kai Hsu, Ting-Jui Chang, Shih-Liang Chen
Divisions of Urology, Tainan Municipal Hospital, Tainan, Taiwan
Background: Reimplantation of the ureter into the bladder is necessary in cases of congenital anomaly or damage to the ureter secondary to pelvic surgery or irradiation. In the old times, laparoscopic surgery made surgeons struggling, because of the difficulty of suturing. Robotic -assisted surgery provided a clearer view and a feasible way to perform the anastomosis. We reported a novel technique that using cystoscopic instruments with “NOTES” concept to assist traditional laparoscopic ureteroneocystostomy, to make it easier.
Case Report: A 27 years-old healthy woman suffered from bilateral flank soreness, and bilateral hydronephrosis and hydroureter were found by abdominal sonography. URS was performed after IVP examination, both showed bilateral lower ureter stenosis with 2 cm in length. Balloon dilatation was performed, but symptoms recurred and hydronephrosis persisted after D-J removed. Therefore, ureteroneocystostomy was offered. Robotic surgery was suggested, but she asked for traditional LPS surgery due to financial problems.
Methods: Bilateral D-J stent was inserted priorly. The patient was lying in prone position. Two 5mm working port and 10mm camera port was set. Bilateral lower ureter was dissected and transected at the dilated part. The second camera system was used to perform cystoscopy. The planned incision site can be located at both video images by the light spot. Bladder was opened by laparoscopic scissor, and D-J could be pulled into the bladder by cystoscopic grasping forceps easily. Following by the suture of the anastomosis. The cystoscopic forceps can by a good tractor to keep the incision site open and prevent the bladder collapsing after urine leaked into peritoneal cavity. The string at the anastomosis of the bladder can be confirmed by the clear view of cystoscopy. After that, modified Lich-Gregoir method was performed to prevent reflux. Symptoms resolved after the operation, renal function was stable, and only mild residual hydronephrosis noted at left kidney.