Novel Method for Placement of a Ureteral Stent during Laparoscopic Ureteroureterostomy

Abstract

Lumbar ureteral benign stenosis can be managed by laparoscopy. Prevention of repeat strictures after ureteral anastomosis includes the placement of a ureteral catheter. When laparoscopy is used to perform the anastomosis, a second position is needed to insert the Double J stent. We provide a way to place the double pigtail ureteral catheter only using laparoscopy.

The ‘amphisbaena’ procedure facilitates antegrade JJ stenting during laparoscopic ureteric reconstruction

“…JJ stent placement is a key part of laparoscopic ureteric reconstruction, which helps to drain urine, prompt healing and prevent stricture recurrence [1]. Compared to preoperative or postoperative retrograde stenting, antegrade placement of a JJS during surgery has significant advantages: (i) avoiding extra cost, damage and infection; (ii) saving approximate 35 min of operating room time [2]; and (iii) separating the ureter's posterior layer from the anterior layer of the ureter, which could help to avoid suturing the posterior and anterior layers of the ureter together.…”

“…Ureteric reconstruction is an important technique for the management of ureteric stricture. The placement of a JJ stent (JJS) after ureteric reconstruction helps to drain urine, prompt healing and prevent stricture recurrence [1]. Postoperative or preoperative cystoscopy or ureteroscopy for retrograde stenting could lead to extended operating time, additional cost, extra damage and possibly retrograde infection [2].…”

“…Antegrade JJS placement is easily performed in open surgery, however, the procedure becomes challenging in laparoscopic operations even in the era of robotic surgery. Although several antegrade JJS placement methods were proposed previously [1,[3][4][5], there is still much room for improvement.…”

Laparoscopic dissection of the intramural ureter to repair a complete transection of the distal ureter: Initial experience with a new minimally invasive technique that preserves the anatomy of the urinary tract

“…This method allowed us to place the ureteral stent without changing the patient's position during laparoscopy, which has been done by other authors. 8 Ureteroureteral anastomosis, with dissection of the distal intramural ureter to obtain Fig. 3.…”

Editorial Comment for Kim et al.

“…3-8 Different antegrade approaches have been described, including the many difficulties that often make them more time consuming. [3][4][5] Other studies have used different materials as a guide (Chiba needle, gauge needle) but with extra punctures. 9, 10 We sometime use these techniques, but frequently experience difficulty with the insertion of the guidewire or stent because of looping in the abdominal cavity or lack of progression because of the angle of insertion into the ureter, with the consequence of prolongation of the surgical procedure.…”