Laparoscopic Ureteroneocystostomy: Modification of Current Techniques
안재현, 한지연, 남종길, 박성우, 이상돈, 정문기,
소속 상세정보
안재현 ( Ahn Jae-Hyun )
Pusan National University Hospital Department of Urology
한지연 ( Han Ji-Yeon )
Pusan National University Yangsan Hospital Department of Urology
남종길 ( Nam Jong-Kil )
Pusan National University Yangsan Hospital Department of Urology
박성우 ( Park Sung-Woo )
Pusan National University Yangsan Hospital Department of Urology
이상돈 ( Lee Sang-Don )
Pusan National University Yangsan Hospital Department of Urology
정문기 ( Chung Moon-Kee )
Pusan National University Yangsan Hospital Department of Urology
KMID : 0358320130540010026
Abstract
Purpose: To review the feasibility of laparoscopic ureteroneocystostomy with extracorporeal eversion of the ureteral end in various distal ureteral lesions.
Materials and Methods: We conducted a retrospective review of 5 laparoscopic procedures of ureteroneocystostomy with extracorporeal eversion of the ureteral end. Of these, 4 patients (range, 45 to 54 years) had distal ureter stricture or obstruction after gynecological surgeries for endometriosis or a large uterine myoma. One patient (male, 67 years) had low-grade distal ureter cancer. The laparoscopic procedure was combined with cystoscopic insertion of a ureteral stent and extracorporeal eversion of the ureter through the 10-mm port on the affected side.
Results: The laparoscopic ureteral reimplantations with and without a psoas hitch in patients with distal ureteral lesions was successful in all patients. The mean operation time was 137 minutes (range, 104 to 228 minutes). Two patients underwent additional psoas hitch. In all patients, short-term success was confirmed by voiding cystourethrography and intravenous pyelography conducted 3 months after the operation. The mean follow-up of the entire group was 12 months (range, 3 to 30 months). We noted no major or minor complications over the follow-up period.
Conclusions: The technique of laparoscopic ureteroneocystostomy for benign or malignant ureteral strictures continues to evolve. Surgeons should be versatile with various options and technical nuances when dealing with these cases. Simple modifications of laparoscopic ureteroneocystostomy with extracorporeal eversion of the ureteral end, nonreflux extravesical anastomosis, and simultaneous cystoscopy will be crucial to the ease of performance and a successful outcome.
키워드
Gynecologic surgical procedures;Laparoscopy;Ureter;Wounds and injuries
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