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| Name | Core Videos (2018): Robotic Ureterocalicostomy |
| Video Uploader | Video From AUAUniversity |
| Upload Date | This Video Uploaded At 11-07-2019 20:04:21 |
| Video Discription | Core Videos (2018): Robotic Ureterocalicostomy For more information, visit: https://auau.auanet.org/core Laura Bukavina, MD, MPH; Kirtishri Mishra, MD; Kyle Scarberry, MD; Vaishnavi Narayanamurthy, MS; Jonathan H. Ross, MD; Lynn L. Woo, MD Introduction: Ureterocalicostomy is an option in patients who have failed previous pyeloplasty, have an intrarenal pelvis, or have significant lower pole caliectasis and limited renal pelvis. The procedure can be performed both transperitoneally and retroperitoneally. Herein, we demonstrate a case of ureterocalicostomy in a patient with a horseshoe kidney with ureteropelvic junction obstruction. Technique: The patient is placed in a flank position, and padded in a standard way for a nephrectomy. A Veress needle is used to gain access the abdomen. A 12 mm camera port is placed just above the umbilicus and two 5 mm ports are placed in the midclavicular line along with an assistant port that is cephalad to the left ASIS in a hockey stick pattern. This patient has a horseshoe kidney, so the ports are placed in anticipation that the kidney will be slightly more caudal. To begin, the colon is reflected medially towards the aorta, and the ureter is identified, which is then traced to the pelvis as proximally as possible. The lower pole is mobilized, and the ureter is transected at the level of the obstruction. Access to the lower pole calyx is obtained using hot shears to excise the lower pole parenchyma. The parenchyma overlying the dilated calyx should be thin, and using hot shears should minimize bleeding. The proximal ureter is spatulated laterally. The anastomosis is performed over a stent using a 5-0 absorbable suture. The first suture is placed at the apex of the ureter and the lateral wall of the exposed calyx. The next suture is placed directly across from the previous suture. The posterior anastomosis is performed first in a running fashion. The anterior anastomosis is performed in an interrupted manner, making sure not to tie down until all sutures are placed circumferentially. The renal capsule can be closed over the cut surface of the kidney, but the capsule should not be closed near the anastomosis to prevent extrinsic compression of the anastomosis. The anastomosis can be protected with a flap (peritoneal or omental) or with a graft from the perinephric fat. A drain is left at the end of the procedure. The stent can be removed six weeks after the surgery if the retrograde ureteropyelogram does not show a leak. Conflict of Interest: None of the authors have any conflicts of interest to disclose. |
| Category | Education |
| Tags | surgery | AUAU | American Urological Association | Urology Core Curriculum | urology | American Urological Association university | urologic | urology surgery video | urology education | AUA Urology Core Curriculum Teaching Videos | surgical | ureterocalicostomy | AUA University | auauniversity | aua | AUAUniversity | AUA Teaching Videos: Robotic Ureterocalicostomy | intrarenal pelvis | AUA Teaching Video | lower pole caliectasis | pediatric urology |
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