LAPAROSCOPIC REPAIR OF CIRCUMCAVAL URETER
Jose B. Mendes,Milton T. Tanaka, Eduado F. Pacagnan, Marcia R. S. S.B. Mendes, Alex S. Tanaka, Katsuyoshi Sumi
Master Clínica, Cascavel, Brazil
Introduction: Circumcaval ureter is a rare congenital condition with few reports describing its laparoscopic management in the literature. Method: A 39-year-old female patient, complaining about recurrent right flank pain, was diagnosed by an intravenous pyelogram (IVP) and a right retrograde pyelogram as bearing a Type 1 circumcaval ureter. The surgery was carried out with de pacient under general anesthesia, at a 45° left lateral decubitus, and a transperioneal approach using three port-sites (two of them, 10 mm and the one remaining 5 mm). After medially displacing the right colon, a complete dissection of the right ureter was carried out, above and below its retrocaval segment. A wide dissection for complete mobilization of the inferior vena cava was also performed. The ureter was divided in its proximal dilated portion and transpositioned anteriorly. The retrocaval segment showed no evidence of dysplasia or stenosis and so, no resection was performed. A 4-0 PDS running suture for the ureteral reconstruction was carried out and no stent was left behind. An excellent peristalsis along the ureter was assured at the end of the procedure. A laminar drain was left in for a few days.
Result: The pacient was discharged at the third post operative day, with minimal pain complaint and the IVP at the 4 week follow-up revealed an excellent renal drainage with remarkable reduction of the uretero-hydronephrosis on the right side.
Conclusion: Considering all the advantages of minimally invasive procedures associated with best cosmetic results, laparoscopy might become a first choice treatment even for reconstruction procedures.