Department of Urologic Surgery, Pediatric Division, 420 Delaware Street S.E., MMC 394, University of Minnesota, Minneapolis, MN 55455, USA.
J Pediatr Urol. 2009 Dec;5(6):475-9. doi: 10.1016/j.jpurol.2009.03.004. Epub 2009 Apr 8.
Ureteropelvic junction obstruction is a common presentation in the pediatric population, but proximal ureteral obstructions are rare. In this setting, robot-assisted laparoscopy (RAL) offers a minimally invasive option to open or traditional laparoscopic repair. The present study demonstrates successful RAL in two children with proximal ureteral obstructions: one with a right retrocaval ureter and one with a left ureter entrapped between two lower-pole crossing vessels.
After retrograde placement of a double-J ureteral stent, the child was secured in a lateral decubitus position exposing the affected side. A three-port RAL system was used to dissect free the obstructed ureter. A spatulated watertight ureteroureterostomy was then fashioned after transposition of the ureter into an anatomic position. Sutures and free instruments were passed into the peritoneal cavity via the 5-mm instrument ports, thus obviating the need for a separate assistant port.
RAL provided for crisp visualization, meticulous dissection, and precise approximation of the reconstructed ureter. In both patients, blood loss was negligible, narcotic use was minimal, and length of stay was roughly 30h. Follow-up imaging at 1 month showed excellent hydronephrosis resolution for both reconstructions.
These two cases demonstrate the feasibility of RAL for proximal ureteral anomalies in the pediatric population.
肾盂输尿管连接部梗阻在儿科人群中较为常见，但近端输尿管梗阻较为罕见。在这种情况下，机器人辅助腹腔镜（RAL）为开放性或传统腹腔镜修复提供了一种微创选择。本研究展示了 RAL 在两名近端输尿管梗阻患儿中的成功应用：一名为右位下腔静脉后输尿管，一名为左输尿管夹在两个下极交叉血管之间。
在逆行放置双 J 输尿管支架后，患儿取侧卧位，暴露受影响的一侧。使用三孔 RAL 系统游离梗阻的输尿管。然后将输尿管转位至解剖位置，形成吻合口。通过 5mm 器械端口将缝线和游离器械送入腹腔，从而避免了单独的助手端口的需要。
RAL 提供了清晰的可视化、精细的解剖和精确的重建输尿管吻合。在这两名患者中，出血量可忽略不计，使用的麻醉药物最少，住院时间约为 30 小时。术后 1 个月的影像学检查显示，两种重建方法均有良好的肾盂积水缓解。
这两个病例证明了 RAL 在儿科人群中治疗近端输尿管异常的可行性。
