Abaza Ronney, Zafar Saleem S
Robotic Urologic Surgery, Ohio State University Medical Center, James Cancer Hospital, Columbus, Ohio, USA.
Urology. 2009 Mar;73(3):582-5. doi: 10.1016/j.urology.2008.08.486. Epub 2009 Jan 14.
Improvements in endoscopic technology have made open ureteral surgery uncommon. There remain cases of ureteral disease not amenable to ureteroscopic treatment, but laparoscopy allows even these complicated cases to be treated in a minimally invasive fashion. Laparoscopic and robotic surgical treatment of the ureter requires the ability to localize the diseased segment laparoscopically, even when the defect is within the lumen and cannot be seen externally or palpated as in open surgery. We describe 3 techniques to localize the disease within the ureter during laparoscopy and robotic surgery and the benefits and limitations of each technique.
Three cases of laparoscopic and robotic ureteral surgery illustrate 3 different techniques used to localize disease within the ureteral lumen. The first case illustrates a ureteral occlusion balloon catheter used to identify a stricture by distending the collecting system proximal to the obstruction and cinching the balloon against the stricture. The second case illustrates a flexible ureteroscope introduced through a 5-mm port and into the incised ureter to guide excision of extensive polyposis. The third case, involving a polyp and stricture, illustrates a technique involving retrograde ureteroscopy with "cutting to the light" laparoscopically.
Three techniques are demonstrated to successfully localize intraluminal ureteral disease that could not be identified visually by laparoscopic inspection alone. These techniques also can minimize the extent of ureteral dissection to preserve blood supply.
Laparoscopy and robotic surgery can be successfully applied to benign ureteral disease not amenable to ureteroscopic treatment. Three cases are presented to illustrate 3 techniques for laparoscopic or robotic localization of intraluminal ureteral disease.
内镜技术的进步使得开放性输尿管手术不再常见。仍有一些输尿管疾病病例不适合输尿管镜治疗，但腹腔镜手术甚至能以微创方式治疗这些复杂病例。输尿管的腹腔镜和机器人手术治疗需要在腹腔镜下定位病变节段的能力，即使缺损位于管腔内，不像开放性手术那样能从外部看到或触诊到。我们描述了在腹腔镜和机器人手术中定位输尿管内疾病的三种技术以及每种技术的优缺点。
三例腹腔镜和机器人输尿管手术病例说明了用于定位输尿管管腔内疾病的三种不同技术。第一例说明了使用输尿管阻塞球囊导管，通过扩张梗阻近端的集合系统并将球囊紧贴狭窄部位来识别狭窄。第二例说明了通过一个5毫米的端口插入柔性输尿管镜进入切开的输尿管，以指导广泛息肉切除术。第三例涉及息肉和狭窄，说明了一种在腹腔镜下进行逆行输尿管镜检查并“向光切割”的技术。
展示了三种技术成功定位仅靠腹腔镜检查无法肉眼识别的输尿管腔内疾病。这些技术还可以尽量减少输尿管解剖范围以保留血供。
腹腔镜和机器人手术可成功应用于不适合输尿管镜治疗的良性输尿管疾病。本文介绍了三例病例，以说明腹腔镜或机器人定位输尿管腔内疾病的三种技术。
