Trans-Mesocolic Laparoscopic Pyeloplasty for left sided Pelvi-Ureteric junction obstruction in Pediatric Patients

  • Ravi P. Kanojia

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The presented video is a case demonstration of Laparoscopic pyeloplasty on left side through trans-mesocolic approach. The renal pelvis on left side usually lies behind the descending colon and the PUJ repair approach is through the mesentery of this colon. Pyeloplasty on left side has its own challenges due to the anatomical location and this video demonstrates the steps to safely do pyeloplasty. The video also demonstrates the retrocloic approach in very selected cases where the kidney is little malrotated.

The video is aimed at Pediatric laparoscopic surgeon, Pediatric urologist, General surgeons with pediatric practice. The viewer will be able to see the basic steps of the procedure with methods of handling the pelvis on left side.

Introduction

This video explains the demonstration of Laparoscopic pyeloplasty on left-sided Pelvi-Ureteric through a trans-mesocolic approach in pediatric patients.

About The Author

Ravi P. Kanojia

Dr Ravi P. Kanojia is a Professor of Paediatric surgery and predominantly practices Paediatric Laparoscopy and Robotic surgery. He has more than 15 years of experience in this field and has done several surgical firsts in the area of Paediatric Laparoscopy. He has trained from several reputed institutions and attended major Paediatric Surgery centres worldwide. His basic Paediatric Surgery training is from King George’s Medical University and following that has been a consultant in PGIMER Chandigarh. He has been a fellow of Paediatric surgery and Paediatric urology at Women’s & Children’s Hospital Adelaide Australia and Juntendo University Tokyo Japan. He has several awards and honours to his name in the field of Paediatric Surgery, including EUPSA travel fellow and WOFAPS fellow.

He has more than 70 publications and several academic positions are served by him. The most notable are as the Editorial secretary of Journal of Indian Association of paediatric Surgeons (PubMed Indexed Journal 2008-2013). He is the current Editorial Manager for Journal of Paediatric Endoscopic Surgery. He is also the Honorary Secretary of Indian Association of Paediatric Surgeons, a society which advises the practice of Paediatric Surgery in the Indian subcontinent.

A detailed information is available on www.clickonravi.com.

The author has a passion towards online teaching with his teaching videos on YouTube platform and there are 100+ paediatric laparoscopy videos posted on his YouTube channel with more than 1300 subscribers and more that 250000 views of the channel.

 

About this video

Author(s)
Ravi P. Kanojia
DOI
https://doi.org/10.1007/978-981-16-5377-3
Online ISBN
978-981-16-5377-3
Total duration
16 min
Publisher
Springer, Singapore
Copyright information
© The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd. 2021

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Video Transcript

Hello, everyone today we are presenting a case of laparoscopic pyeloplasty for left sided pelvic-ureteric junction obstruction. This video will demonstrate trans-mesocolic laparoscopic approach, for approaching the hydronephrotic kidneys on the left side. I am Dr. Ravi Kanojia from PGIMER Chandigarh. So we will start with some basic introduction.

Hydronephrotic kidney for pyeloplasty on the left side is approached differently than the right side, because of the unique position of the kidney pelvis and in the direction in which the hydronephrotic pelvis is going to bulge. It’s usually through the mesocolon or the splenic flexure the large bowel. It is approached through the mesocolon on the left side and retrocolic approach is usually done for the right side kidney, where you have to reflect the colon down and away from the kidney pelvis in order to get the exposure. So this is what we are going to demonstrate in our video.

So the video is going to show the beginner’s perspective for approach to kidney on the left side of the pyeloplasty. Certain nuances of laparoscopic pyeloplasty are also shown in this particular video. How to hitch the pelvis, how to suture the posterior and the anterior layer of the anastomosis and placing a double J stent.

Going on to some of the clinical details of the current patient which we are demonstrating. So this is a 2-year-old boy with left sided hydronephrosis. He has a normal ureter on ultrasound and his A-P diameter is around 12mm for the pelvis. His renal diuretic scan is showing obstructed drainage curve on the diuretic scan.

So the procedure done in this patient is trans-mesocolic laparoscopic pyeloplasty. This is some of the board positioning where you can see that the patient is lying supine and is rolled over to elevate the operative side up. This also facilitates to drop the bowel away from the kidney and helps you with the exposure. So here you are using the gravity as the assistant. You can also take note of the ports. The umbilical port is a 10mm or a 5mm camera port and then you have two lateral working ports which you can see here marked by this dotted arrows. So this position is very, very important in these patients in order to have a pyeloplasty procedure unhindered by the presence of small bowel, which will usually keep coming in your way.