Abstract
Purpose
To present our surgical techniques for retroperitoneal laparoendoscopic single-site (LESS) pyelopyelostomy for retrocaval ureter and our initial experience with this method in 4 patients.
Methods
From June 2010 to May 2011, 4 patients with retrocaval ureter underwent retroperitoneal LESS pyelopyelostomy with a homemade single-port device and standard straight laparoscopic instruments. The single-port device was made with a surgical glove and Foley catheter and allowed the introduction of three trocars. A 3-cm incision was made at the middle axillary line, midway between the iliac crest and the twelfth rib. The retrocaval segment of the ureter was mobilized and transposed anteriorly to the inferior vena cava. The pyelopyelostomy anastomosis was completed with intracorporeal freehand suturing. A double-pigtail ureteral stent assembly was implanted in 3 of the 4 patients.
Results
All retroperitoneal LESS pyelopyelostomies were successful without conversion to standard laparoscopy or open surgery. The mean operating time was 105 min (range, 90–135 min). The mean blood loss was 18 mL (range, 5–50 mL). None of the patients required blood transfusion. The double-pigtail ureteral stent was removed 4–6 weeks postoperatively. The mean postoperative hospital stay was 7.3 days (range, 6–9 days). No intraoperative or postoperative complications occurred. At a mean follow-up of 10 months, excellent improvement in the ureteral obstruction was observed.
Conclusions
We report our initial experience using LESS for the treatment of retrocaval ureter. Our results in 4 patients suggest that this minimally invasive approach is a feasible treatment of retrocaval ureter. Long-term follow-up of more cases is needed to confirm its benefits.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Raman JD, Bensalah K, Bagrodia A, Stern JM, Cadeddu JA (2007) Laboratory and clinical development of single keyhole umbilical nephrectomy. Urology 70:1039–1044
Rane A, Kommu S, Eddy B, Bonadio F, Rao P, Rao P (2007) Clinical evaluation of a novel laparoscopic port (R-port) and evolution of the single laparoscopic port procedure (SLiPP). J Endourol 21(Suppl 1):A22–A23
Kaouk JH, Autorino R, Kim FJ et al (2011) Laparoendoscopic single-site surgery in urology: worldwide multi-institutional analysis of 1076 cases. Eur Urol 60:998–1005
Greco F, Cindolo L, Autorino R, Micali S, Stein RJ, Bianchi G, Fanizza C, Schips L, Fornara P, Kaouk J (2012) Laparoendoscopic single-site upper urinary tract surgery: assessment of postoperative complications and analysis of risk factors. Eur Urol 61:510–516
Pienkny AJ, Herts B, Streem SB (1999) Contemporary diagnosis of retrocaval ureter. J Endourol 13:721–722
Baba S, Oya M, Miyahara M et al (1994) Laparoscopic surgical correction of circumcaval ureter. Urology 44:122–126
Salomon L, Hoznek A, Balian C et al (1999) Retroperitoneal laparoscopy of a retrocaval ureter. BJU Int 84:181–182
Autorino R, Khanna R, White MA et al (2010) Laparoendoscopic single-site repair of retrocaval ureter: first case report. Urology 76:1501–1505
Matsuda T, Yasumoto R, Tsujino T (1996) Laparoscopic treatment of a retrocaval ureter. Eur Urol 29:115–118
Polascik TJ, Chen RN (1998) Laparoscopic ureteroureterostomy for retrocaval ureter. J Urol 160:121–122
Gupta NP, Hemal AK, Singh I et al (2001) Retroperitoneoscopic ureterolysis and reconstruction of retrocaval ureter. J Endourol 15:291–293
Ramalingam M, Selvarajan K (2003) Laparoscopic transperitoneal repair of retrocaval ureter: report of two cases. J Endourol 17:85–87
Li HZ, Xin Ma X, Qi L, Shi TP, Wang BJ, Zhang X (2010) Retroperitoneal laparoscopic ureteroureterostomy for retrocaval ureter: report of 10 cases and literature review. Urology 76:873–876
Coleman JA (2012) Laparoendoscopic single-site surgery for the upper urinary tract: awaiting evidence. Eur Urol 61:517–519
Olweny EO, Mir SA, Best SL et al (2012) Importance of cosmesis to patients undergoing renal surgery: a comparison of laparoendoscopic single-site (LESS), laparoscopic and open surgery. BJU Int 110(2):268–272
Zhang X, Shi TP, Li HZ, Ma X, Wang BJ (2011) Laparo-endoscopic single site anatomical retroperitoneoscopic adrenalectomy using conventional instruments: initial experience and short-term outcome. J Urol 185:401–406
Canes D, Desai MM, Aron M et al (2008) Transumbilical single-port surgery: evolution and current status. Eur Urol 54:1020–1029
White WM, Haber GP, Goel RK, Crouzet S, Stein RJ, Kaouk JH (2009) Single-port urological surgery: single-center experience with the first 100 cases. Urology 74:801–804
Jeong BC, Park YH, Han DH, Kim HH (2009) Laparoendoscopic single-site and conventional laparoscopic adrenalectomy: a matched case-control study. J Endourol 23:1957–1960
Ryu DS, Park WJ, Oh TH (2009) Retroperitoneal laparoendoscopic single-site surgery in urology: initial experience. J Endourol 23:1857–1862
Jeon HG, Jeong W, Oh CK et al (2009) Initial experience with 50 laparoendoscopic single site surgeries using a homemade, single port device at a single center. J Urol 183:1866–1871
Chung SD, Huang CY, Wang SM, Tai HC, Tsai YC, Chueh SC (2009) Laparoendoscopic single-site (LESS) retroperitoneal adrenalectomy using a homemade single-access platform and standard laparoscopic instruments. Surg Endosc 25:1251–1256
Acknowledgments
The authors declare that they have no conflict of interest.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Kang, N., Zhang, Jh., Niu, Yn. et al. Retroperitoneal laparoendoscopic single-site surgery for the treatment of retrocaval ureter. World J Urol 31, 205–211 (2013). https://doi.org/10.1007/s00345-012-0965-3
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00345-012-0965-3