Chester J. Koh, MD

 is a resource for urologists and other clinicians who focus on men's health. 'Y'tube covers surgical aspects of a variety of men's health issues with the ultimate goal of accumulating a library of videos to serve as a reference. This installment looks at ureteral reimplantation. Typically done for vesicoureteral reflux, iureteral reimplantation is one of the most common major procedures in pediatric urology. Its use in the adult population, however, is rare. Often, urologists are called in to perform a ureteral reimplant due to iatrogenic trauma, or the procedure is done as part of other reconstructive urologic surgeries in the care of pediatrics patients with spina bifida transitioning to adult care. The use of meticulous tissue handling and tips and tricks for a seamless and efficient ureteral reimplant serve as a reference for any ureteral surgery as well as a reminder of what adult urologists may encounter on caring for these young adults transitioning out of pediatric urologic care.

	This video demonstrates a top-down approach without the use of stents for robot-assisted laparoscopic extravesical ureteral reimplantation in children. This represents a minimally invasive option for children that has been associated with high success rates and low complication rates similar to those of open surgery.

The robot-assisted laparoscopic extravesical ureteral reimplant has gained popularity in recent years. Success and complication rates have varied in the literature. As a result, it is critical that modifications and technical considerations such as those presented in Dr. Koh’s video are shared.

	The video highlights Dr. Koh and colleagues’ top-down suturing technique for closing the detrusor muscle over the ureter. The initial stitch is placed at the “top” or proximal end of the detrusor tunnel. This step promotes ease of suturing the rest of the tunnel and helps keep the ureter out of the way to avoid injury and increase visibility during suturing. The authors’ published results have demonstrated this to be a very reliable technique in their hands.

 We are now entering an era where many residents will finish their training being more comfortable with robotic surgery than open surgery. Thus, being facile with robotic ureteral reconstructions will become vital to both urologic care and repairing iatrogenic injuries, both urologic and otherwise. This video illustrates the core principles of robotic ureteral surgery.

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In this video, Chester J. Koh, MD, shows key steps in a top-down approach without the use of stents for robot-assisted extravesical ureteral reimplantation.

Author | Chester J. Koh, MD

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Ureteral reimplantation: Top-down approach