A simple technique of ureteric spatulation & handling during laparoscopic pyeloplasty in infants & children

Laparoscopic pyeloplasty is being performed successfully in children with results comparable to open pyeloplasty. Pediatric laparoscopic pyeloplasty, however, remains a technically demanding procedure. Some of the most difficult, time-consuming, and at the same time critical steps of the procedure are ureteral spatulation and intracorporeal suturing of the anastomosis. It is also preferable to avoid grasping the ureter with any instrument. The difficulty of ureteral spatulation has led to the development of some technical modifications, including an ex-vivo spatulation technique. In our own practice, we tried some modifications to overcome this challenging part of the procedure. We have finally developed a technique that simplifies this surgical step. This technique can be performed with simple conventional laparoscopic instruments and is easily reproducible.