3 research outputs found
Laparoscopic repair of iatrogenic long ureteral injury
Introduction: Transection of the ureter
in laparoscopic retroperitoneal lymph
node dissection (RPLND) is a rare iatrogenic
complication. Its repair is possible
by end-to-end anastomosis when the defect
is short, but if there is a long defect,
laparoscopic repair is a challenge.
Methods: A 30-year-old man underwent
modified RPLND of a clinically stage-A
mixed germ cell of the left testis. While
cutting the gonadal vein, 1.5 cm of the
ureter was transected 2 cm below the
renal pelvis and clipped by one of our
residents. The injury was diagnosed immediately.
After the completion of the modified
RPLND, the clips were removed and
a 20-mm defect of the ureter was seen
precluding anastomosis. The kidney was
dissected and pulled down 35 mm. The
lower pole of the kidney was then fixed
to the psoas muscle by a 2-0 vicryl, making
anastomosis possible after an 8-mm
spatulation of both sides. Anastomosis was
done over a stent by interrupted sutures
using 4-0 vicryl.
Results: Leakage was 400 mL at the first
postoperative day and ceased at the 4th
day. On the control excretion urography,
the kidney function was normal and a fullness
of the caliceal system was seen.
Conclusion: Long defect of the ureter
that may occur in laparoscopic urological
surgeries could be manageable laparoscopically
using methods for shortening of
the interval such as relocation of the kidney.
Thus, a same approach as open surgeries
can yield acceptable results in laparoscopic
surgeries