Ex-vivo ureteral spatulation during laparoscopic pyeloplasty: a novel approach to a difficult problem

Ureteral spatulation and performance of the anastamosis to the renal pelvis are the most important and often technically demanding and time consuming steps in performing a laparoscopic pyeloplasty. We describe a novel ex-vivo technique of ureteral spatulation and placement of the apical anastamotic sutures. This technique is especially helpful in challenging cases where optimal angles may not be viable via pure laparoscopic technique. The technique was performed on six patients, five pediatric and one adult without any immediate complications or long-term stricture or anastamotic disruption.