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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.

Plasty of pelvic ureter segment

Plasty of pelvic ureter segment
Professor Gallyamov E.A. is performing an operation (2013).

In this film the technique of plasty of right pelvic ureter segment is presented. Troacars are introduced at their typical points for instruments (3x10 mm, 1x5 mm) under the guidance of optics. Access to the hilum of kidney is done by means of bringing down the hepatic angle of the large colon and dissection of tissues between Toldt’s fascia and fascia Gerotae by a 5 mm Harmonic Scalpel Ethicon instrument and instruments of Karl Storz Company. Mobilization of the lower pole of the right kidney is done, ureter is exposed at the level of its transition into pelvis. The pelvis has the following sizes: 4x4 cm. The ureter is dissected from the pelvis and is opened at the length of 2.5 cm in the longitudinal direction by the endoscopic scissors. Resection of the enlarged area of the pelvis is performed (the size 3x2 cm). The formation of pyeloureteroanastomosis (Anderson-Heins’s operation) has been performed, using continuous suture and “Polysorb” thread. A stent has been inserted into the pelvis through the ureter wound. Silicone drainage Ethicone has been placed into the paranephral space and in the area of anastomosis.

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