title: Laparoendoscopic single-site repair of retrocaval ureter: first case report.
abstract: OBJECTIVE
  We describe a case of retrocaval ureter treated with laparoendoscopic single-site surgery (LESS).
  
  
  METHODS
  A 26-year-old female was referred to our institution with a history of intermittent right-sided flank pain. Radiological imaging demonstrated hydronephrosis, suggesting the presence of a retrocaval ureter. A LESS repair was planned.
  
  
  RESULTS
  Retrograde pyelogram confirmed a classic appearance for retrocaval ureter. A ureteral stent was positioned. The patient was placed in modified flank position. A 2-cm, completely concealed umbilical access was created, through which a single port access platform was positioned. An in-line endoscope was used for visualization. Articulating instruments were used during initial dissection. The entire ureter was mobilized posterior to the vena cava and transected at the caudal-most point where the dilated portion of the proximal ureter ended. The distal ureter was repositioned lateral to the inferior vena cava and spatulated laterally. The proximal ureter was spatulated medially. Two 4-0 Vicryl sutures were used for the ureteroureteral anastomosis. A separate 2-mm grasper placed in the right lower quadrant was used to assist with suture reconstruction. A drain was left through the umbilicus. Blood loss was minimal. Total operative time was 3 hours. The patient was discharged on postoperative day 2. At the 3-month follow-up, diuretic radionuclide scan revealed no evidence of obstruction of the right kidney and the patient was symptom-free.
  
  
  CONCLUSIONS
  Albeit challenging, LESS repair for retrocaval ureter is a feasible procedure that can be considered as a treatment option for this rare anatomic anomaly.
authors.affiliation: Center for Laparoscopy and Robotic Surgery, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH 44195, USA. ricautor@tin.it
authors.forename: Riccardo
authors.initials: R
authors.lastname: Autorino
authors.forename: Rakesh
authors.initials: R
authors.lastname: Khanna
authors.forename: Michael A
authors.initials: MA
authors.lastname: White
authors.forename: Georges-Pascal
authors.initials: GP
authors.lastname: Haber
authors.forename: Gaurang
authors.initials: G
authors.lastname: Shah
authors.forename: Jihad H
authors.initials: JH
authors.lastname: Kaouk
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Stein
mesh_terms: D000328:Adult; D000714:Anastomosis, Surgical; D004724:Endoscopy / Q000379:methods*; D005260:Female; D021501:Flank Pain / Q000209:etiology; D006801:Humans; D006869:Hydronephrosis / Q000209:etiology / Q000601:surgery*; D010535:Laparoscopy / Q000379:methods*; D015607:Stents; D013536:Suture Techniques; D014513:Ureter / Q000002:abnormalities* / Q000601:surgery*; D014682:Vena Cava, Inferior