Retroperitoneal laparoendoscopic single-site surgery for the treatment of retrocaval ureter.
OBJECTIVE
To present our surgical techniques for retroperitoneal laparoendoscopic single-site (LESS) pyelopyelostomy for retrocaval ureter and our initial experience with this method in 4 patients.


METHODS
From June 2010 to May 2011, 4 patients with retrocaval ureter underwent retroperitoneal LESS pyelopyelostomy with a homemade single-port device and standard straight laparoscopic instruments. The single-port device was made with a surgical glove and Foley catheter and allowed the introduction of three trocars. A 3-cm incision was made at the middle axillary line, midway between the iliac crest and the twelfth rib. The retrocaval segment of the ureter was mobilized and transposed anteriorly to the inferior vena cava. The pyelopyelostomy anastomosis was completed with intracorporeal freehand suturing. A double-pigtail ureteral stent assembly was implanted in 3 of the 4 patients.


RESULTS
All retroperitoneal LESS pyelopyelostomies were successful without conversion to standard laparoscopy or open surgery. The mean operating time was 105 min (range, 90-135 min). The mean blood loss was 18 mL (range, 5-50 mL). None of the patients required blood transfusion. The double-pigtail ureteral stent was removed 4-6 weeks postoperatively. The mean postoperative hospital stay was 7.3 days (range, 6-9 days). No intraoperative or postoperative complications occurred. At a mean follow-up of 10 months, excellent improvement in the ureteral obstruction was observed.


CONCLUSIONS
We report our initial experience using LESS for the treatment of retrocaval ureter. Our results in 4 patients suggest that this minimally invasive approach is a feasible treatment of retrocaval ureter. Long-term follow-up of more cases is needed to confirm its benefits.
Urology Department, Beijing Chao Yang Hospital, Capital Medical University, No.8 of Gongti North Road, Chaoyang District, Beijing, 100020, China. Ning.kang@chinamedicalnews.net
Ning
N
Kang
Jun-hui
JH
Zhang
Yi-nong
YN
Niu
Jian-wen
JW
Wang
Xi-quan
XQ
Tian
Yan
Y
Yong
Nian-zeng
NZ
Xing
D000328:Adult; D005260:Female; D006801:Humans; D007682:Kidney Pelvis / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D012187:Retroperitoneal Space; D016896:Treatment Outcome; D014513:Ureter / Q000002:abnormalities; D014517:Ureteral Obstruction / Q000151:congenital / Q000601:surgery*; D014547:Urinary Diversion / Q000379:methods*