Laparoscopic reconstruction of the ureter: a survival canine study

ABSTRACT

Laparoscopic reconstruction of the ureter is a rarely visited domain in literature. Such reconstructive procedures, performed via conventional surgery, are common in our practice for management of Bilharzial and Tuberculous ureteric strictures, congenital malformations and iatrogenic trauma to the ureter. Ureteroneocystostomy, Boari flap and ileal replacement of the ureter are the procedures of choice in management of the whole spectrum of ureteral defects with high success rates for the open surgical procedures. To present our initial experience with experimental laparoscopic ureteroneocystostomy, Boari flap and ileal replacement of the ureter aiming at evaluation of such procedure and gaining experience prior to clinical application. Twelve healthy Mongrel dogs stratified into three groups. Each dog was subjected to one of three different levels of ureteric obstruction for one renal unit. Group 1 included 4 females for which juxtavesical obstruction of one ureter was done, Group 2 included 4 females for which obstruction was made at the lower part of the lumbar ureter and Group 3 which included 3 males and 1 female for which high lumbar obstruction was performed. Laparoscopic ureteroneocystostomy was performed for group I dogs, laparoscopic Boari flap for group 2 and laparoscopic ileal replacement of the ureter for group 3. All dogs survived the procedures, operative time ranged from 140 to 360 minutes [mean 253 +/- 70 minutes] and overall success rate was 83.33% as one renal unit lost function and one dog died on the second postoperative day. Laparoscopic reconstruction of the ureter with simple or complex procedures is technically feasible and safe. Standard laparoscopic armamentarium is quite sufficient for such procedures. Further experimentation is needed to outline the learning curve and to evaluate more techniques. Owing to our initial experience, we can conclude that clinical application of such procedures would be an achievable target in the hands of devoted laparoscopic surgeons who have good experience with reconstructive laparoscopic surgery