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Laparoscopic assisted continent urinary diversion in the pig
K R Anderson1, P T Fadden, K Kerbl
1Department of Surgery (Urology), Yale University, New Haven, Connecticut 06510, USA.
The Journal of Urology
|November 1, 1995
Summary
Laparoscopic creation of a continent urinary diversion using a sigmoid-rectum pouch is feasible in pigs. A "dunked" ureterocolonic anastomosis showed better or equal drainage compared to hand-sewn methods.
Area of Science:
- Urology
- Minimally Invasive Surgery
- Surgical Reconstruction
Background:
- Continent urinary diversion aims to create a low-pressure, nonrefluxing reservoir.
- Hohenfellner described a sigmoid-rectum pouch for in situ ureterosigmoidostomy.
- Laparoscopic techniques offer potential for improved reconstructive surgery.
Purpose of the Study:
- To laparoscopically create a continent sigmoid-rectum urinary diversion in an animal model.
- To compare the efficacy of a "dunked" ureterocolonic anastomosis versus a hand-sewn end-to-side anastomosis.
Main Methods:
- Laparoscopic creation of a continent urinary diversion in nine male domestic pigs.
- Extracorporeal pouch creation and ureterocolonic anastomoses without ureteral stents.
- Study duration of 10 to 12 weeks with survival assessment.
Main Results:
- Mean pouch capacity was 360 cc with pouch pressure < 20 cm.H2O.
- Stones formed on the bowel staple line in 44% of animals.
- Ureterocolonic obstruction occurred in 11% of "dunked" (right) and 33% of hand-sewn (left) anastomoses.
Conclusions:
- Laparoscopic continent sigmoid-rectum diversion is feasible.
- "Dunked" ureterocolonic anastomosis is equivalent or superior to hand-sewn.
- Stone formation on staple lines requires further investigation and resolution.