title: Robot-Assisted Laparoscopic Extravesical Ureteral Reimplantation in Children: Top-Down Suturing Technique Without Stent Placement.
abstract: Extravesical robotic-assisted laparoscopic ureteral reimplantation in children is a challenging procedure. Our top-down suturing technique facilitates this reconstructive surgery. After mobilization of the ureter without the use of ureteral stent placement, the detrusor muscle is divided. Once adequate muscle flaps are raised, the ureter is placed into its new muscle tunnel. Unlike previously described techniques, the top-down suturing approach involves placement of the first detrusor stitch at the superior aspect. This allows the ureter to be elevated out of harm's way and in a tension-free manner. The rest of the detrusor reapproximation is performed in a top-down approach with interrupted sutures without the need for ureteral elevation or manipulation. This technique facilitates the suturing process and decreases trauma to the ureter with less instrument contact. This helps to prevent potential complications and improve success rates associated with this procedure.
authors: Division of Pediatric Urology, Department of Surgery, Texas Children's Hospital; and Scott Department of Urology, Baylor College of Medicine , Houston, Texas.
authors: Mesrur Selcuk
authors: MS
authors: Silay
authors: Division of Pediatric Urology, Department of Surgery, Texas Children's Hospital; and Scott Department of Urology, Baylor College of Medicine , Houston, Texas.
authors: Minki
authors: M
authors: Baek
authors: Division of Pediatric Urology, Department of Surgery, Texas Children's Hospital; and Scott Department of Urology, Baylor College of Medicine , Houston, Texas.
authors: Chester J
authors: CJ
authors: Koh
mesh_terms: D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D009130:Muscle, Smooth / Q000601:surgery; D019651:Plastic Surgery Procedures / Q000379:methods; D012092:Replantation / Q000379:methods*; D065287:Robotic Surgical Procedures / Q000379:methods*; D015607:Stents; D013536:Suture Techniques; D014513:Ureter / Q000601:surgery*; D014718:Vesico-Ureteral Reflux / Q000601:surgery*