Laparoscopic ureteral reconstruction: intracorporal reconfiguration of ileum and colon in a porcine model.
OBJECTIVE
Long ureteral defects can be reconstructed in humans with reconfigured short colonic or ileal segments. We undertook the present study to evaluate whether laparoscopy with completely intracorporal reconfiguration could replicate open surgery results.


METHODS
In eight renoureteral units of six pigs, a ureteral defect of 4.5 to 8.0 cm (mean 6.6 cm) was created. Ileum was used for reconstruction in six renal units and colon in two. A 3-cm-long segment was isolated from the intestinal tract and transversely reconfigured into a long pedicled tubular graft, which was then interposed into the ureteral defect. Reconfiguration and all anastomoses were performed by freehand intracorporal suturing and knot-tying.


RESULTS
Reconstruction was successful in all cases. No significant blood loss or open conversions occurred. The mean total surgical time was 296 minutes (range 234-353 minutes).


CONCLUSIONS
Ureteral repair with intracorporally reconfigured intestinal segments is technically feasible. Clinical application will await survival studies.
Ubrig
Burkhard
B
Department of Adult and Pediatric Urology, University of Witten/Herdecke, Wuppertal, Germany. bubrig@wuppertal.helios-klinken.de
Lazica
David
D
Waldner
Michael
M
Roth
Stephan
S
D000714:Anastomosis, Surgical; D000818:Animals; D003106:Colon / Q000637:transplantation*; D007082:Ileum / Q000637:transplantation*; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D023421:Models, Animal; D013536:Suture Techniques; D013552:Swine; D014513:Ureter / Q000293:injuries / Q000601:surgery*