ESPU Congress 2018 - Abstract Book

202

CONGRESS OF THE ESPU

MATERIAL AND METHODS

We performed a retroperitoneal robot-assisted laparoscopic in a 13-year-old boy (40 kg) with no

past medical history. The child turned to be symptomatic (flank pain). The diagnosis of UPJO was

confirmed by renal ultrasound (60 mm pyelocaliceal dilatation) and MAG-3 renal scan (severe

impairment of renal function).

The child was positioned laterally. A15 mm incision was made just above the iliac crest in the anterior

axillary line. The retroperitoneal space was entered and created with the camera (8-mm; O°). Two

other 8-mm robotic trocars were placed, with one assistant trocart. After opening Gerota’s fascia,

minimal dissection was done just to free the UPJ, and a traction suture, placed at the junction,

was inserted through the abdominal wall. Due to aberrant polar vessels, the ureter was completely

divided and the UPJ and the pelvis were delivered anterior to the vessels with the help of the traction

suture. Then the ureteropelvic anastomosis (Anderson-Hynes pyeloplasty) was performed, using

a 6–0 monofilament absorbable suture with a 3/8 circle needle. After stent placement, the posterior

part of the anastomosis was completed. No drainage tube was left in situ.

RESULTS

Set-up time, from skin incision until the end of docking, was 54 min. Surgeon’s console time was

141 min. Total operating time was 195 minutes with no resultant blood loss. He recovered well and

was discharged home on postoperative day 1.

At 6 months, the patient remains without symptoms.

CONCLUSIONS

Retroperitoneal robot-assisted laparoscopic is feasible, safe and effective. It is an excellent option

with ideal anatomical exposure.

VD-10 (VS without presentation)

TECHNICAL ADVANCEMENTS IN SCROTAL MOBILIZATION

FOR CORRECTION OF PENILE CONCEALMENT

Gregory MCMAHON

, Zarine BALSARA

and Gregory DEAN

1) Rowan University, Urology, Stratford, USA - 2) Urology For Children, Temple For Urology, St Christopher's Hospital

for Children, Pediatric Urology, Voorhees, USA

PURPOSE

We have previously described a technique to correct penoscrotal webbing associated with penile

concealment. Division of midline scrotal fat permits posterior scrotal repositioning and effectively

eliminates the penoscrotal web without dividing it. The distal foreskin unfurls providing ventral shaft

skin. We have modified this technique to achieve enhanced cosmesis.

MATERIAL AND METHODS

The penile base and penoscrotal junction are first carefully marked to ensure accurate placement

of prepubic tacking sutures to achieve a normal penopubic junction. Leaving a generous 1.5 cm

mucosal collar eliminates the risk of incorporating cicatrix in the shaft. Next, a ventral incision is

made from the mucosal collar to insertion of the scrotal web without dividing the web. The penis

is degloved to penopubic and penoscrotal junctions. Scrotal retraction exposes midline scrotal fat

which is incised enabling posterior scrotal repositioning. Penopubic and penoscrotal junctions are

defined and fixed with sutures ~ 4.5 cm from the tip of the glans. Scrotal repositioning unfurls

ventral skin yielding appropriate coverage. Byars' flaps are created dorsally and sutured to the

collar followed by ventral closure. Lateral skin is excised and the circumcision is completed with

monofilament quadrant sutures followed by Dermabond.