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CONGRESS OF THE ESPU
MATERIAL AND METHODS
Transmesocolic RALP-HIdES was performed in a 8-years old girl suffering from left UPJ obstruc-
tion. Before docking the robot, 75 degree right lateral decubitis position was given to the patient.
Only the three arms of "da Vinci Xi" robot was used. One of the eight-milimeter robotic trocars was
placed into the umblicus; the second one was placed at a point on midline and one-centimeter
above the symphysis pubis; and the third one was placed at a point one-centimeter above and
eight-centimeter left lateral to the second one.
RESULTS
No collison of robotic arms to each other was detected. Assistant port is not needed. Attention was
necessary in lower trocars' access into the abdomen due to the close localization of intestines.
The classical steps of "dismembered pyeloplasty" were performed succesfully and without any
complication. No orientation problem was felt due to caudal to cranial sight of the robotic camera to
the operation field. Double-J cathether was easily placed. Total anesthesia time and total operation
time were 120 and 95 minutes, respectively. The postoperative period was uneventful.
CONCLUSIONS
Performing pyeloplasty with a robot using HIdES technique is a safe and fast procedure, and also
has the advantage of avoiding visible scars on abdominal wall. Surgeon orientation is also easy, and
the use of assistant port is not necessary. Preferring transmesocolic approach seems to shorten
the operative time.
VD-25 (VS without presentation)
APPENDIX INTERPOSITION FOR LEFT URETERAL
RECONSTRUCTION
Alberto PARENTE, Laura BURGOS, Ruben ORTIZ and Jose María ANGULO
Gregorio Marañon University Hospital, Pediatric Urology, Madrid, SPAIN
PURPOSE
Extensive ureteral loss in children is a rare but dramatic event. Appendix interposition has been
described as an option for surgical reconstruction of partial and total ureteral defects both in children
and adults.
MATERIAL AND METHODS
We report a case of left ureteral reconstruction in a solitary kidney and long-term follow-up with ure-
teroscopy. An 8-year-old boy was referred to our hospital with a left pyelostomy and absence of the
right kidney. Pyelostomy has been performed after necrosis of the left ureter secondary to ureteral
reimplantation performed as the obstructive megaureter treatment. A new ureteral reimplantation
with interposition of the appendix was proposed. The Gregoir technique was used in the bladder
anastomosis.
RESULTS
Postoperative recovery was uneventful. After 4 years, the child was asymptomatic with normal renal
function. Ultrasound showed residual renal dilatation, so we decided to perform control ureteros-
copy, as it is shown in the video.
CONCLUSIONS
Left ureteral reconstruction using the vermiformis appendix is a feasible procedure even in young
children. Long-term ureteroscopy showed a good adaptation of the appendix to the urinary tract.