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Laparoscopic cross-trigonal Cohen ureteroneocystostomy: novel technique
I S Gill1, L E Ponsky, M Desai
1Section of Laparoscopic and Minimally Invasive Surgery, Urological Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA.
The Journal of Urology
|October 5, 2001
Summary
This study introduces a new laparoscopic technique for ureteral reimplantation to treat vesicoureteral reflux. The novel transvesical cross-trigonal approach shows promise for effective reflux management with potential benefits.
Area of Science:
- Urology
- Minimally Invasive Surgery
- Pediatric Surgery
Background:
- Vesicoureteral reflux (VUR) is a common condition in children, potentially leading to kidney infections and damage.
- Traditional open ureteral reimplantation can involve significant morbidity.
- Laparoscopic techniques offer potential advantages in reducing surgical trauma.
Purpose of the Study:
- To describe and evaluate a novel laparoscopic transvesical cross-trigonal Cohen anti-reflux ureteroneocystostomy technique.
- To assess the feasibility and initial outcomes of this minimally invasive approach for VUR.
Main Methods:
- Three patients with symptomatic unilateral VUR underwent laparoscopic ureteral reimplantation.
- A transvesical cross-trigonal submucosal trough was created using a resectoscope.
- Ureters were mobilized, advanced, and secured with sutures in a freehand laparoscopic technique.
Main Results:
- The procedure was technically feasible in all cases, with operative times ranging from 2.5 to 4.5 hours.
- Successful creation of submucosal tunnels and ureteral anchoring was achieved.
- Two of three patients achieved complete resolution of reflux at 6 months; one showed improvement.
Conclusions:
- Laparoscopic transvesical cross-trigonal ureteral reimplantation is technically feasible.
- Intravesical laparoscopic suturing is achievable, enabling minimally invasive repair.
- Potential benefits include shorter hospital stays, reduced pain, and improved cosmesis compared to open surgery.