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Anterior Layer and DJ Stent Insertion
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Trans-Mesocolic Laparoscopic Pyeloplasty for left sided Pelvi-Ureteric junction obstruction in Pediatric Patients
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With the spatulated ureter the first stitch is taken at the angle. This is the most important suture with knot done outside the lumen. The posterior layer is done in a continuous fashion.
Keywords
- Pelvi-ureteric junction obstruction
- ureter
- hydronephrosis
Conflict of Interest
The author declares no conflict of interest.
About this video
- Author(s)
- Ravi P. Kanojia
- First online
- 30 July 2021
- DOI
- https://doi.org/10.1007/978-981-16-5377-3_4
- Online ISBN
- 978-981-16-5377-3
- Publisher
- Springer, Singapore
- Copyright information
- © The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd. 2021
Video Transcript
So this is our first stitch, which will be placed at the angle of the spatulated ureter. This is the most important stitch and sets the tone for the rest of the pelvic anastomosis. So the knot is going to lie outside. You can see the entire orientation of the ureter is still maintained. Because the last bit is still attached to the upper part of the pelvis.
Once our first few stitches are in place, we are going to disconnect the pelvic ureter junction entirely. So there goes our first stitch. And we have started with the posterior layer anastomosis now. These are the initial few stitches. The knot should lie outside the ureter.
The suturing continues upwards to the posterior layer in a continuous fashion. Attempt is made to achieve fine suturing with adequate sized bites.
At this stage, we will ask the operative assistant to get ready with the D J Stent Because once the posterior layer is completed, the stent will be placed in. So we are gradually completing the posterior layer of the anastomosis.
And we have utilized the entire length of this spatulated ureter, no? At this stage, a knot will be tied to complete the anastomosis. Now this knot, whether it stays inside or outside, does not matter. Because it is a divided portion of the pelvis.
Final knots are being placed for completion of the posterior layer. The suture is divided. So now, the remainder of the ureter and the pelvis can be divided. And we can retrieve this part as the specimen.