Silicone drainage

Laparoscopic plasty of pelvicoureter segment and nephropexy

Laparoscopic plasty of pelvicoureter segment and nephropexy
Professor Puchkov K.V. is performing an operation (2016).

In this video the technique of plasty of right pelvicoureter segment is presented. The access to the kidney hilum is by means of bringing down the hepatic angle of the large colon and dissection of tissues between fascia Gerotae and Toldt’s fascia with the help of a 5 mm LigaSure ( MEDTRONIC COVIDIEN) instrument and instruments of Karl Storz Company. Mobilization of the anterior surface of kidney and periosteum of the 12-th rib, of the lower pole of the right kidney; ureter is exposed at the level of transition to pelvis. At the first stage fixation of the soft mesh implant MEDTRONIC COVIDIEN to the periosteum of the 12-th rib and kidney capsule is done by placing an atraumatic suture, using separate interrupted stitches, with monofilament thread. After dissection pelvis (sizes 4x4 cm) is found out at the hilum of the kidney. Ureter is dissected from pelvis and is opened at the length of 2.5 cm in the longitudinal direction by endoscopic scissors. Resection of the enlarged area of pelvis is done. The next stage is formation of anastomosis, using interrupted and continuos suture, with “Polysorb” 4-0 thread. A stent is inserted into the pelvis through the ureter wound. And silicone drainage Ethicon is placed into the paranephral space and in the area of anastomosis. Mesh implant is covered by the parietal abdomen. Operation duration is 1 hour 50 minutes.