title: Laparoscopy in ureteral engineering: a feasibility study.
abstract: OBJECTIVE
  We recently bioengineered a ureter substitute from a seeded scaffold implanted by open surgery in the omentum. In view of the development of laparoscopy in the treatment of benign conditions of the ureter, obtaining a ureter substitute by minimally invasive techniques would be a desirable objective. However, conflicting results about the biological impact of carbon dioxide insufflation on the microcirculation of intra-abdominal organs prompted us to investigate first whether the results obtained by open surgery, in terms of vascular supply and maturation, could be reproduced laparoscopically.
  
  
  METHODS
  Bladder full-thickness tissue was harvested laparoscopically from three pigs for urothelial and smooth muscle cell primary cultures subsequently used to seed a small intestinal submucosa (SIS) matrix. After 2 wk, the in vitro seeded constructs were shaped around silicone drains and transferred laparoscopically into the abdomen for omental maturation. Three weeks later, the constructs were harvested for histological, immunohistochemical, and electron microscopic analysis.
  
  
  RESULTS
  The laparoscopic procedures were performed successfully in all animals. After omental maturation, the constructs were vascularized and comprised of a well-differentiated multilayered urothelium with umbrella cells, over connective tissue and smooth muscle cells, with no evidence of fibrosis or inflammation. Electron microscopic analysis showed characteristics of a terminally differentiated urothelium.
  
  
  CONCLUSIONS
  As shown by conventional microscopy, immunochemistry, and electron microscopy, carbon dioxide insufflation does not impact cell growth and differentiation. These findings validate the laparoscopic approach for omental maturation of ureter substitutes.
authors.affiliation: Department of Urology, Paris Saint Joseph Hospital Trust, Paris, France. baumertherve@yahoo.fr
authors.forename: Hervé
authors.initials: H
authors.lastname: Baumert
authors.forename: Mehrak
authors.initials: M
authors.lastname: Hekmati
authors.forename: Irene
authors.initials: I
authors.lastname: Dunia
authors.forename: Dhouha
authors.initials: D
authors.lastname: Mansouri
authors.forename: Walid
authors.initials: W
authors.lastname: Massoud
authors.forename: Vincent
authors.initials: V
authors.lastname: Molinié
authors.forename: E Lucio
authors.initials: EL
authors.lastname: Benedetti
authors.forename: Bernard
authors.initials: B
authors.lastname: Malavaud
mesh_terms: D000818:Animals; D017690:Cell Transplantation / Q000379:methods; D002478:Cells, Cultured; D004195:Disease Models, Animal; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D010535:Laparoscopy / Q000379:methods*; D009130:Muscle, Smooth / Q000166:cytology* / Q000637:transplantation; D009852:Omentum; D013552:Swine; D023822:Tissue Engineering / Q000379:methods*; D054457:Tissue Scaffolds; D014513:Ureter / Q000601:surgery*; D014517:Ureteral Obstruction / Q000601:surgery*; D001743:Urinary Bladder / Q000166:cytology; D019459:Urothelium / Q000166:cytology* / Q000637:transplantation