A simplified technique for ureteral spatulation in laparoscopic pyeloplasty.

Abstract:

:One of the most difficult, time-consuming, and at the same time critical steps of laparoscopic pyeloplasty is ureteral spatulation. We describe a reproducible technique that greatly simplifies this surgical step. Using standard laparoscopic scissors, the ureter is partially cut just inferior to the ureteropelvic junction (UPJ) at a point where a normal (nonstenotic) ureter is discerned. This first cut involves only half of the circumference of the ureter. The ureter remains attached to the UPJ. Through the most cephalad port, a 5-mm articulating laparoscopic scissors is inserted in the abdomen. The instrument is fully articulated so that the axis of the jaws is almost in line with the ureteral axis. The jaws are opened, one jaw is inserted in the ureteral lumen, and the ureter is spatulated to the requisite length. At this point, the first apical ureteral stitch is placed outside-in while the ureter is stabilized by its remaining attachment to the UPJ. Subsequently, the ureter is freed completely from the UPJ; the UPJ is excised, and the rest of the procedure is performed in a standard fashion.

journal_name

J Endourol

journal_title

Journal of endourology

authors

Giannakopoulos S,Efthimiou I,Bantis A,Kalaitzis C,Touloupidis S

doi

10.1089/end.2011.0354

subject

Has Abstract

pub_date

2012-06-01 00:00:00

pages

618-20

issue

6

eissn

0892-7790

issn

1557-900X

journal_volume

26

pub_type

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