Diseases of ureter

Laparoscopic reimplantation of the ureter in surgical treatment of endometriosis infiltration

Laparoscopic reimplantation of the ureter in surgical treatment of endometriosis infiltration.
Professor M.Malzoni (2018) is performing an operation

The patient, aged 30, has infiltrating endometriosis, invading to the anal wall and the right ureter. In this video the technique of the exposure of endometrioid infiltrate by means of the bipolar forceps and endoscopic scissors with the preliminary exposure of the right ureter up to the stenosis level is presented. Then the transection of the colon by the linear endoscopic stitching apparatus is immediately performed when infiltration is noticed. Then, using a 5-mm Thunderbeat Olympus instrument, dissection of the urinary bladder is performed. When the urinary bladder is inflated, the right wall of it is fixed to the lumbar muscle. The ureter and the urinary bladder are opened, and the ureter stent is inserted into the lumen. Then anastomosis is performed between the urinary bladder and the ureter by the interrupted suture, using “Polysorb” thread.

Possibilities of thullium lithotripsy of different localization

Possibilities of thullium lithotripsy of different localization
Professor Martov A.G. is performing an operation (2017).

Ureterolithotripsy, using thullium laser

Ureterolithotripsy, using thullium laser.
Professor Martov A.G. is performing an operation.

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.

HoLEP endopyelotomy

HoLEP endopyelotomy
Professor Martov A.G. is performing an operation (2016).

In this video the technique of performing HoLEP endopyelotomy under the guidance of electronic optic transformer (EOT), is presented. Endoscopic operations, aimed at restoration of urine passage in the upper urinary tract, are considered to be highly efficient and less invasive. Operation duration is not more than 30 minutes. At the first stage ureteroscopy is performed, then retrograde ureterolithoscopy, HoLEP correction of stricture zone, and kidney draining by means of internal stent placing.

Laparoscopic approach in treatment of the retrocervical endometriosis, stage 4. Uteterolysis

Laparoscopic approach in treatment of the retrocervical endometriosis, stage 4. Uteterolysis.
The operation is performed by Professor Puchkov K.V. (2015 )

A 31 year-old patient is operated on for retrocervical infiltrating endometriosis, invading to the wall of rectum and vagina, uterine cervix and sacrouterine ligaments. Both ureters are involved into the infiltration. In this video the safe technique of consecutive exposure of the right and left ureters by means of a 5 mm monopolar electrode and a 5 mm Liga Sure MEDTRONIC COVIDIEN instrument is demonstrated. For the better visualization of the surgical site compulsory temporary fixation of ovaries, using transabdominal stitching, is done. Using the soft forceps, the tubular structures are exposed subperitoneally, moving them aside from the endometrioid centre. While dissecting tissues on the left, the change of the anatomy of ureter positioning due to the infiltrative changes in this area has been clearly seen. During dissection it has been found out that the ureter is shifted to the right, coming into close contact with the right ureter. One should bear in mind possible changes of anatomy in this area in order not to injure ureters during the dissection of the endometrioid centres.

You can read about this technique in detail on the personal cite of Professor Puchkov Konstantin Viktorovich. To go to the link.

Laparoscopic placing of ureter anastomosis

Laparoscopic placing of ureter anastomosis
Professor Puchkov K.V. is performing an operation (2014).

In this film the technique of placing ureter end-to-end anastomosis is presented in case of termotrauma (if happened 2 days ago) -total transection of ureter. The exposure of proximal and distal parts of ureters by a 5 mm Sonicision scissors (MEDTRONIC COVIDIEN), inserting ureter stents and excision of affected edges. Then, using “Polysorb” 4-0 thread, an atraumatic suture is placed for end-to-end ureter anastomosis. Operation duration is 40 minutes.