Robotic assisted lower ureteric reimplantation with psoas hitch repair following an iatrogenic injury

Abstract

Background: The risk of injury to the ureter during an abdominal hysterectomy is estimated at 1.3% [1]. This injury often occurs following ligation of the uterine vessels as the ureter crosses under the artery. Objective: To illustrate a minimally-invasive approach in the surgical management of a distal ureteric injury. Method: A 45 year old female was reviewed in an outpatient setting with a left nephrostomy insitu following an intraoperative injury to her left distal ureter during a hysterectomy for a large fibroid. An initial attempted endoscopic realignment procedure was unsuccessful. Operative method: The ureter was mobilised proximal to healthy tissue with preservation of the adventitia. The bladder was mobilised and a psoas hitch performed to ensure a tension free anastomosis. The ureter was then spatulated and anastomosed into the bladder over a JJ stent. Results: The patient had an uneventful post-operative course and was discharged home on day 4 with the JJ stent and urinary catheter insitu. At post-operative day 14, the patient returned for a urinary catheter removal, cystoscopy and JJ stent removal, the ureteric reimplantation was found to be successful. Conclusion: A robotic assisted technique is a safe and effective approach for distal ureteric reimplantation.

Keywords

• Robotic
• Ureteric
• Reimplantation
• Psoas hitch
• Minimally invasive