title: A simple and safe technique for trocar positioning in vesicoscopic ureteric reimplantation.
abstract: OBJECTIVE
  Anchoring of the urinary bladder to the anterior abdominal wall is essential to prevent perivesical gas leak and dislodgement of trocar. Existing techniques have the risk of going through the peritoneal cavity and injuring the bowel. Our aim was to find a safe technique to anchor the bladder wall to the abdominal wall.
  
  
  METHODS
  Nineteen cases were studied prospectively. A curved urethral dilator was introduced and made to point on the anterior abdominal wall. Abdominal wall was incised over the tip of the dilator till the bladder was seen which was then sutured to the anterior abdominal wall. The bladder was then incised and the trocars were railroaded on the dilator into the bladder. Cohen's reimplantation was then done.
  
  
  RESULTS
  Out of the 19 cases, conversion to open was done in two early cases. In one case, the trocar got pulled out, but was easily reintroduced. Mean operating time was 210 min. Mean follow up was 20.9 months. There was a resolution of reflux in 13, reduction in the grade of reflux in 1 and no failures. In five cases, post op MCU is awaited.
  
  
  CONCLUSIONS
  This technique of fixing the bladder to the anterior abdominal wall is safe and easy to perform. It is recommended while doing vesicoscopic reimplantation.
authors.affiliation: Department of Pediatric Surgery, Amrita Institute of Medical Sciences, Kochi, Kerala, India. mohanabraham@aims.amrita.edu
authors.forename: Mohan K
authors.initials: MK
authors.lastname: Abraham
authors.forename: Naveen
authors.initials: N
authors.lastname: Viswanath
authors.forename: S
authors.initials: S
authors.lastname: Bindu
authors.forename: Prashanth
authors.initials: P
authors.lastname: Kedari
authors.forename: P
authors.initials: P
authors.lastname: Ramakrishnan
authors.forename: Aisha
authors.initials: A
authors.lastname: Naaz
authors.forename: Sharon
authors.initials: S
authors.lastname: Mohan
mesh_terms: D002675:Child, Preschool; D003558:Cystoscopy; D004867:Equipment Design; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D008297:Male; D011446:Prospective Studies; D012092:Replantation / Q000379:methods*; D013536:Suture Techniques / Q000295:instrumentation*; D013537:Sutures; D016896:Treatment Outcome; D014513:Ureter / Q000601:surgery*; D001743:Urinary Bladder / Q000601:surgery*; D014554:Urination; D013520:Urologic Surgical Procedures / Q000295:instrumentation*; D014718:Vesico-Ureteral Reflux / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*