Haydarpasa Numune Med J. 2020; 60(3): 271-278 | DOI: 10.14744/hnhj.2018.91259

Transperitoneal Laparoscopic Repair of the Retrocaval Ureter: Our Single-Center Experience

Serdar Aykan¹, Ahmet Ürkmez¹, Musab Ali Kutluhan², Mustafa Zafer Temiz³, Atilla Semerciöz³, Ahmet Yaser Müslümanoðlu^3
1Department of Urology, University of Health Sciences Turkey, Haydarpaþa Numune Health Application and Research Center, Istanbul, Turkey
²Department of Urology, University of Health Sciences Turkey, Fatih Sultan Mehmet Health Aplication and Research Center, Istanbul, Turkey
³Department of Urology, University of Health Sciences Turkey, Bagcilar Health Aplication and Research Center, Istanbul, Turkey

INTRODUCTION: We aimed to describe our experience in transperitoneal laparoscopic repair of retrocaval ureter (RCU) in this study.
METHODS: Between February 2010 and February 2017, five patients (1 female and 4 males) who underwent laparoscopic repair with the diagnosis of RCU in our department were included in this study. Patients’ mean age was 27 (range 20–32 years). All patients were pre-operatively evaluated using ultrasonography (US) followed by contrast-enhanced computed tomography (CT) intravenous pyelography (IVP). After CT diagnosis of RCU, all patients underwent diuretic renography examination with 99mTc-DTPA. Laparoscopic surgery was performed by the transperitoneal approach using the three-dimensional (3D) vision system in two and two-dimensional vision system (2D) in three patients.
RESULTS: All operations were completed laparoscopically without conversion to open surgery. Mean operation time was 168.5±9.89 minutes. Operation time of two patients in whom 3D a vision system was used was shorter (155 and 165 minutes) comparing to others in whom 2D vision systems used. Blood loss was less than 50 mL in all patients. Obliterated ureteric segments were excised in four patients. Four patients were symptom-free after surgery and had regression of hydronephrosis in their kidneys. In one of the cases, there was no resolution of hydronephrosis postoperatively.
DISCUSSION AND CONCLUSION: Careful dissection along the planes with good tissue respect and good hemostasis during each step are the key to success for laparoscopic repair of RCU. Pure laparoscopic treatment of RCU seems feasible and technically reliable. At the same, time using a 3D vision system, if available would be preferable because of the dissection and intracorporeal suturing advantages.

Keywords: Laparoscopy, minimal invasive surgery; retrocaval ureter.

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Retrokaval üreterin laparoskopik transperitoneal onarýmý: Tek merkez deneyimimiz

Serdar Aykan¹, Ahmet Ürkmez¹, Musab Ali Kutluhan², Mustafa Zafer Temiz³, Atilla Semerciöz³, Ahmet Yaser Müslümanoðlu^3
1Haydarpasa Numune Eðitim ve Araþtýrma Hastanesi, Uroloji Kliniði, Istanbul
²Fatih Sultan Mehmet Eðitim ve Araþtýrma Hastanesi, Uroloji Kliniði, Istanbul
³Bagcilar Eðitim ve Araþtýrma Hastanesi, Uroloji Kliniði, Istanbul

GÝRÝÞ ve AMAÇ: Retrokaval üreterin (RCU) laparoskopik transperitoneal onarýmýndaki tecrübemizi tanýmlamak.
YÖNTEM ve GEREÇLER: Þubat 2010 ve Þubat 2017 yýllarý arasýnda, kliniðimizde RCU tanýsý ile laparoskopik onarým uygulanan beþ hasta (1 kadýn ve 4 erkek) çalýþmaya alýndý. Hastalarýn yaþ ortalamasý 27 (20–32) idi. Tüm hastalar ameliyat öncesi, ilk olarak ultrasonografi (US) ile sonrasýnda kontrastlý bilgisayarlý tomografi (BT) ve intravenöz pyelografi (IVP) ile deðerlendirildi. RCU' nun BT tanýsýndan sonra tüm hastalara 99mTc-DTPA ile diüretik renografi incelemesi yapýldý. Laparoskopik cerrahi, üç olguda iki boyutlu (2D) görüntüleme sistemi, iki olguda ise üç boyutlu (3D) görüntüleme sistemi kullanýlarak transperitoneal yaklaþýmla yapýldý.
BULGULAR: Tüm operasyonlar açýk cerrahiye geçilmeden laparoskopik olarak tamamlandý. Ortalama operasyon süresi 168 ± 9 dakika idi. 3 boyutlu görüntüleme sisteminin kullanýldýðý iki hastanýn operasyon süresi, 2 boyutlu görüntü sisteminin kullanýldýðý hastalara göre daha kýsa (155 ve 165 dakika) idi. Tüm hastalarda peroperatif kan kaybý 50 mL' den azdý. Oblitere üreter segmenti 4 hastada çýkarýldý. Dört hasta cerrahi sonrasý semptomsuzdu ve böbreklerindeki hidronefrozda gerileme vardý. Olgulardan birinde postoperatif dönemde hidronefroz rezolüsyonu görülmedi.
TARTIÞMA ve SONUÇ: Retrokaval üreterin laparoskopik onarýmýnda baþarýnýn anahtarý, dokuya saygý, iyi hemostaz ile düzlem boyunca diseksiyonun saðlanmasýdýr. RCU' nun saf laparoskopik tedavisi uygulanabilir ve teknik olarak güvenilir görünmektedir. Ayný zamanda 3D görme sistemi kullanýlarak diseksiyon ve intrakorporeal dikiþ atma avantajlarý nedeniyle tercih edilebilir.

Anahtar Kelimeler: Retrokaval üreter, minimal invazif cerrahi, laparoskopi

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