Minimally Invasive Ureteroureterostomy

Abstract

Technological advances have not only enhanced our ability to detect urological disease but also resulted in dramatic changes/advancements in the tools available to treat them. Up until recently, laparoscopic techniques in pediatric urology had been confined mainly to academic centers given the challenges associated in learning the techniques or the high learning curve. However, the addition of the robot to our surgical armamentarium has dramatically expanded the role of minimally invasive surgery as well as its breadth of use. Pioneers continue to develop and push the boundaries as innovations evolve. The scope of procedures performed is now ever expanding, and it includes complex ureteral surgery. Previously, the delicate nature of intracorporeal suturing and the fine tissue handling required limited the applicability of laparoscopic techniques of this sort to very few expert laparoscopists. The robotic systems, however, have facilitated a shortened learning curve in addition to improved precision and performance. As these changes have occurred, surgeons have begun to tackle more challenging problems including the ureteroureterostomy. The general concept of repair remains the same: restore the normal flow of urine. In this chapter, the author describes in detail his approach to an obstructed superior moiety ureter of a duplex system associated with a normal inferior moiety ureter and collecting system. The author has performed these both laparoscopically and robotically, but his preference now is to use the robot. A detailed description of his preoperative, intraoperative, and postoperative management follows.