Laparoscopy-assisted ureterostomy- technique

Area of Science:

• Pediatric Surgery
• Minimally Invasive Surgery
• Urology

Background:

• Urinary tract anomalies in children often necessitate immediate urinary diversion.
• Open cutaneous ureterostomy is a standard but invasive approach.
• A less invasive alternative is needed for these challenging pediatric cases.

Purpose of the Study:

• To describe and evaluate the feasibility of a laparoscopy-assisted cutaneous ureterostomy.
• To present early outcomes of this minimally invasive technique in pediatric patients.

Main Methods:

• Transperitoneal laparoscopy was performed using three ports, with one working instrument inserted through the ureterostomy site to minimize scarring.
• Laparoscopic identification, mobilization, and excision of the dilated ureter were conducted.
• The ureteric loop was exteriorized to fashion the ureterostomy, with proximal and distal patency confirmed.

Main Results:

• Nineteen pediatric patients underwent the procedure for various conditions including VUR, neuropathic bladder, and posterior urethral valves.
• The mean operative time was 40 minutes, with patients discharged within 72 hours.
• At three months, clinical and ultrasound reviews indicated stable upper tracts and no urinary tract infections (UTIs).

Conclusions:

• Laparoscopy-assisted ureterostomy is a quick and feasible technique, even in neonates.
• It allows for precise dissection and tensionless ureter exteriorization, ensuring prompt drainage.
• This approach offers potential benefits over traditional open surgery for pediatric urinary diversion.