V01-12: Robot assisted ureteral reimplantation side-to-side with Boari flap

Abdel Bakayoko*, mehdi el akri, Lucas Freton, Juliette Hascoet, Zinne-eddine Khene, Vivien grafeille, gregory verhoest, Andrea Manunta, mathieu romain, Karim bensalah, Rennes , France, Lee ZHAO, new york, NY, Benoit Peyronnet, Rennes , France

Introduction: Stenoses of the distal ureter are often managed by ureterovesical reimplantation or reimplantation into the psoic bladder. These techniques are sometimes insufficient in the event of stricture rising above the iliac vessels. In addition, they require a complete section of the ureter likely to compromise its vascularization. The objective of this video was to present a technique without transection.

Methods: We present the case of a 62-year-old female patient with a history of pseudomyxoma treated with intraperitoneal chemotherapy, omentectomy, bilateral adnexectomy, appendectomy, splenectomy and cholecystectomy. The patient presented following her intraperitoneal chemotherapy, with bilateral ureteral stricture for which she has been treated by bilateral nephrostomy for 18 months. It is decided to have a surgical management in two stages (right ureter then left ureter). On the right there is a stricture of the distal ureter rising above the iliac vessels.

Results: The patient is positioned in Tredelenburg at 23 °. A transperitoneal laparoscopic approach is performed. The Da Vinc Xi robot is docked sideways. After bladder filling, the Retzius space is dissected and the lateral surfaces of the bladder are dissected widely. The ureter is dissected above the iliac vessels, taking care to preserve its vascularity. IV injection of incdocyanine green and nephrostomy helps to ensure the quality of the blood supply and to identify the stricture. Incision on the anterior face of the ureter of about 2 cm then arcuate opening of the anterior face of the bladder in order to create the bladder flap which is moored as high as possible on the psoas. Lateral anastomosis of the bladder flap at the ureteral incision. Closure of the Boari flap by 2 V Lock hemi-injectors. The postoperative follow-up was straightforward, the patient was discharged on D3 and had no recurrence of her stenosis at 3 months.

Conclusions: Here we describe a simplified robot-assisted Boari flap technique without trans-section with latero-lateral anastomosis. This technique can allow the minimally invasive treatment of extensive strictures of the distal ureter rising above the iliac vessels.

Source of Funding: No source founding