Laparoscopic Anterior transposition of Ureter

Laparoscopic Anterior Transposition of the Ureter is a surgical procedure to reposition the ureter, typically performed in cases of retrocaval ureter or other anatomical abnormalities that compress or obstruct the ureter, impairing normal urine flow.

This minimally invasive approach offers precise correction with reduced pain, faster recovery, and minimal scarring compared to traditional open surgery.

Indications

The procedure is primarily indicated for:

• Retrocaval ureter: A congenital anomaly where the ureter passes behind the inferior vena cava (IVC), leading to obstruction.
• Compression by vascular structures: Such as aberrant veins or arteries.
• Chronic ureteral obstruction: Resulting in hydronephrosis (kidney swelling), recurrent infections, or impaired kidney function.
• Failed outcomes from conservative or endoscopic management.

Preoperative Preparation

1. Imaging and Diagnosis:

   • CT urography, MRI, or intravenous pyelography to confirm the diagnosis and assess the ureter’s position and degree of obstruction.
   • Functional tests (e.g., renal scintigraphy) to evaluate kidney function.

2. Patient Counseling:

   • Discuss procedure steps, benefits, risks, and expected recovery.

3. Anesthesia:

   • Surgery is performed under general anesthesia.

Surgical Procedure

1. Positioning:

   • The patient is placed in a lateral decubitus position to allow access to the retroperitoneal area.

2. Trocar Placement:

   • 3-4 small incisions are made for the laparoscopic instruments and camera.

3. Retroperitoneal Dissection:

   • The surgeon carefully locates and mobilizes the ureter and identifies the inferior vena cava (or other obstructive structures).

4. Ureteral Mobilization and Transposition:

   • The ureter is gently freed from its abnormal posterior position (behind the IVC or compressive structure).
   • It is then repositioned anteriorly to bypass the obstruction.

5. Ureteroplasty (if needed):

   • If significant narrowing or damage is present, the affected ureteral segment is reconstructed (e.g., spatulated and reanastomosed).

6. Stent Placement:

   • A temporary ureteral stent is often inserted to facilitate healing and ensure proper urine flow.

7. Closure:

   • The incisions are closed with sutures or surgical adhesive after ensuring proper positioning and flow.