Laparoendoscopic Single-site Repair of Retrocaval Ureter Without any Special Devices
RAFAEL B. REBOUÇAS, RODRIGO C. MONTEIRO, PORFÍRIO F. DE MEDEIROS JÚNIOR, ANTÔNIO C. MADRUGA NETO, MARCOS M. SOARES JUNIOR, CAMILA N. GUEDES, RÍCIA N. P. MOURA, GERALDO CAMILO NETO, GUSTAVO M. C. DE ALENCAR, GIÁCOMO F. SOUZA, CESAR A. BRITTO
Department of Urology, Edson Ramalho Military Police Hospital, João Pessoa, PB, Brazil
The retrocaval ureter is a rare congenital anomaly. The extrinsic compression may be responsible for obstruction and pain symptoms. The laparoscopic approach has been used with good results and less morbidity than the open surgery. Herein we describe a case of retrocaval ureter treated with LESS. To our knowledge, this represents the second such case reported in the literature, and the first without using any special devices, such as, single port or bended instruments.
Female, 23 years, complaining of right low back pain for a long time and recurrent urinary tract infection. Renal ultrasound demonstrated right-sided hydronephrosis and intravenous urography suggested the presence of retrocaval ureter. DTPA renal scintigraphy confirms delay in the elimination of contrast through the right kidney. A laparoendoscopic single-site repair was planned.
The total operative time was 145 min. The blood loss was minimal. The patient was discharged on the third postoperative day and resumed total activity about 10 days after surgery. The double J was removed within 4 weeks.
Albeit technically challenging, LESS repair for retrocaval ureter might represent a feasible new treatment option for this rare anatomic anomaly. Special devices could help on the procedure, however they are not essencials.
Int Braz J Urol. 2012; 39 (Video #1): 141-142
Dr. Rafael B. Rebouças
Edson Ramalho Military Police Hospital
Eugênio Lucena Neiva, s/n - Treze de Maio
João Pessoa, PB, 58.025-020, Brazil
In the video by Dr. Rebouças and colleagues, a less (laparoendoscopic single site) technique for retrocaval ureter repair was nicely illustrated. This will be the second case reported in the literatura, after Autorino and collegues in 2010 (1). Operative time was similar to laparoscopic series. Ureteroureterostomy can be challenging using a minimally invasive approach, and that increses using a less technique. A suture to keep the ureter in place was used by the authors to facilitate the anastomosis. As with other procedures, minimally invasive thechniques offer cosmetic advantages as well as quicker recovery and less pain. Minimally invasive surgery gains more popularity for ureteric reconstruction type procedures as this described in the video, with LESS procedure as an option for retrocaval ureter repair.
Dr. Jose Jaime Correa