How do I do it: Abdominal wall closure device-assisted minimally invasive cutaneous ureterostomy using a "loop-lift"
Chenghao Zhanghuang1, Zhiwei Wang2, Guanrong Zhao3
1Department of Urology, Children's Hospital of Kunming Medical University, Kunming Children's Hospital, Kunming 650103, Yunnan, China; Yunnan Key Laboratory of Children's Major Diseases Research, Yunnan Province Clinical Research Center for Children's Health and Disease, Yunnan Clinical Medical Center for Pediatric Diseases, Kunming 650500, Yunnan, China.
Insights
This study introduces an abdominal wall closure device (AWCD)-assisted minimally invasive cutaneous ureterostomy (CU) for infants needing urgent urinary diversion. The technique simplifies ureteral exposure and facilitates rapid diversion before further reconstruction.
Area of Science:
- Pediatric Surgery
- Urology
- Minimally Invasive Surgery
Background:
- Infants with severely dilated ureters often require urgent urinary diversion.
- Traditional methods for cutaneous ureterostomy (CU) can involve extensive ureteral mobilization.
- Minimally invasive approaches are desirable for pediatric surgical procedures.
Purpose of the Study:
- To describe a novel technique for minimally invasive cutaneous ureterostomy (CU) in infants using an abdominal wall closure device (AWCD).
- To simplify the procedure for urgent urinary diversion in cases of markedly dilated ureters.
Main Methods:
- Laparoscopic visualization was employed for the procedure.
- An abdominal wall closure device (AWCD) was utilized to create a suture loop beneath the dilated ureter.
- This "loop-lift" maneuver facilitated controlled, extraperitoneal elevation of the ureter to a skin incision.
Main Results:
- The AWCD-assisted technique allowed for controlled ureteral elevation with minimal mobilization.
- The "loop-lift" maneuver simplified ureteral exposure and reduced tissue handling.
- This method provides a reproducible pathway for rapid urinary diversion.
Conclusions:
- Abdominal wall closure device-assisted minimally invasive cutaneous ureterostomy is a feasible technique for urgent urinary diversion in infants.
- The "loop-lift" maneuver offers advantages in ureteral exposure and procedural simplification.
- This approach facilitates rapid diversion prior to definitive reconstructive surgery in pediatric patients.
Abstract:
We describe an abdominal wall closure device (AWCD)-assisted minimally invasive cutaneous ureterostomy (CU) for young infants who require urgent, low-pressure diversion due to markedly dilated ureters (e.g., duplex-system ureterocele with high-grade reflux or other severe reflux/obstructive scenarios). Under laparoscopic vision, the AWCD is used to deliver and retrieve a suture loop beneath the markedly dilated ureter, enabling controlled elevation of the ureter along an extraperitoneal trajectory to a small skin incision with minimal ureteral mobilization. This "loop-lift" maneuver simplifies ureteral exposure, reduces tissue handling, and provides a reproducible pathway for rapid diversion prior to definitive reconstruction.
