Retrocaval ureter, also called as circumcaval ureter, it was a rare congenital anomaly with an estimated incidence of 1 in 1000 live births. Surgical treatment for the correction of retrocaval ureter includes excision of the retrocaval part with relocation & ureteropelvic reanastomosis or ureteroureteral through an open approach.
PROCEDURE:
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The patient’s were catheterized on the supine position & the catheter was clamped to keep the bladder distended to aid in the consequent placement of JJ stent. The patient were then changed to left lateral position.
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Pneumoperitoneum was produced by using a veress needle. 4 ports are then placed. A 12 mm camera port were placed along with the lateral border of rectus abdominis over the umbilicus & 2 8 mm robotic ports was introduced inside the mid clavicular line, one under the costal margin & one at the spinoumbilical line.
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Fourth 12 mm ports were placed in the centerline at either below or above the umbilicus for assistant to help the suction & retraction. The Da Vinci robot is then docked from the back of the patient.
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The hepatic flexure of the right colon is identified & mobilized to give exposure to right sided retroperitoneal structures. The right renal pelvis & inferior vena cava are recognized.
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Then right renal pelvis & proximal ureter was freed of soft tissue attachments. The proximal ureter is seen disappearing at the back of the inferior vena cava. Transection is done at the pelvis & at the proximal ureter.
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The retrocaval segment of the ureter were not excised & left in situ. Ureteroureterostomy was done and pyelopyelostomy. After transection at the proximal ureter or pelvis, the distal segment were transposed anterior to inferior vena cava.
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Then pyelopyelostomy or ureteroureterostomy were done by using the 4-0 continuous polyglactin suture.
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After completion of either anterior or posterior layer of anastomosis, antegrade stenting is performed by using a 6F JJ stent. The rest of the anastomosis is completed over the stent & a 14F Romovac suction drain were placed.
