Transvesical Laparoscopic Cross-Trigonal Ureteral Reimplantation for Correction of Vesicoureteral Reflux: Initial Experience and Comparisons Between Adult and Pediatric Cases

Abstract

This procedure was an effective and safe alternative minimally invasive procedure for both adult and pediatric patients with reflux.

Transvesicoscopic Ureteral Reimplantation in Children with Bilateral Vesicoureteral Reflux: Surgical Technique and Results

“…Its actual role in meeting the theoretical advantages of laparoscopic surgery without deteriorating treatment outcome also seems to be inconclusive. [8][9][10][11]17 Concerns that the technique might have a steep learning curve 8,9 and would be compromised in cases of small bladder capacity 8-10 seem to be the main reasons for its limited use.…”

“…One noticeable aspect in this step was that we made a minor modification during the repair of the bladder floor: When retracting the mobilized ureter during repair of the bladder muscular defect, we used an additional 2-mm puncture grasper inserted at the midpoint of the abdomen. Other methods for retracting the ureter exist; for example, Valla et al 10 and Kawauchi et al 11 used a 3-mm device through the urethral route. However, we think that such an approach cannot be used in very young pediatric patients because their urethral diameters are often too narrow to pass the proper equipment for the procedure.…”

“…Recently, transvesicoscopic cross-trigonal ureteral reimplantation (TVUR) under CO 2 pneumovesicum was introduced to minimize surgical trauma and serve as an alternative to open Cohen's surgery. Since the initial report, 7 six reports [7][8][9][10][11][12] have been published; these studies have suggested that TVUR can be performed safely and effectively with a high success rate and minimal invasiveness.…”

Guidelines for the medical management of pediatric vesicoureteral reflux

“…The laparoscopic transvesical Cohen’s technique has a success rate (91–96%) close to that of open surgery . However, the difficulty of the procedure and relatively long learning curve should be considered to carry out this laparoscopic surgery.…”

"Spaghetti Maneuver": A useful tool in pediatric laparoscopy - Our experience

“…[2][3][4] Pneumovesicoscopic ureteral reimplantation is also an alternative minimally invasive procedure, effective and safe in both adult and pediatric patients with severe vesicoureteral reflux (VUR) and recurrent urinary tract infections (UTIs), especially in cases where a previous endoscopic correction has failed. It yields good results, [5] it is associated with less postoperative morbidities and a shorter hospital stay compared to the traditional open method, [6] and has a high success rate (92-95% of cases). [7] Unfortunately, unlike in adults, in pediatric patients the laparoscopic workspace is rather limited, often making it difficult to isolate the anatomical structures involved, as well as dissection and knotting maneuvers.…”