Garrahan U-Stitch laparoscopic appendicovesicostomy – Making surgery easierAppendicovesicostomy is an established continent urinary conduit. The development of minimally invasive techniques and the reduction of operative time instigated the search for new techniques. In this video we show the laparoscopic transabdominal technique for appendicovesicostomy using U-stitch technique as proposed by Santiago Weller et al. We present a case of a teenager with neurogenic bladder and intolerance for urethral catheterization. The procedure was performed using a transperitoneal approach.
Upper lip graft (ULG) for redo urethroplasties in children. A step by step videoLower lip and cheek are commonly used sources of buccal mucosa grafts for urethroplasty. In recent years, aiming to improve the donor site morbidity, our preference changed to the use (ULG). The aim of this video is to illustrate the technical details of the ULG harvesting for children.
Robot-assisted laparoscopic diverticulectomy with ureteral reimplantationThe objective is to describe our experience with robot-assisted laparoscopic diverticulectomy with extravesical ureteral reimplantation in a pediatric patient.
The search for continence in bladder exstrophy: Bladder neck transection and Macedo catheterizable reservoir to augment the nativebladderBladder exstrophy remains one of the most challenging abnormalities in pediatric urology. We propose bladder neck transection and bladder augmentation with a catheterizeable reservoir technique to achieve continence after previous anatomic reconstruction in stages.
Phalloplasty in biological men with penile insufficiencyPhalloplasty for penile insufficiency in biological men differs from trans-men by incorporating native tissue. The study objective was to report surgical and functional outcomes of phalloplasty in biological men.
The GUD technique: Glandular urethral disassembly for distal hypospadias repairWe present an alternative procedure for distal hypospadias consisting of urethral mobilization and glandular disassembly, named GUD-technique.
Robot-assisted laparoscopic pyelotomy and ileal ureter substitution: video demonstrationWhile robot-assisted laparoscopic (RAL) ileal ureter substitution is a known treatment option for managing recurrent ureteral stricture, video documentation of this procedure is lacking. This article aims to visually demonstrate the surgical technique used in an RAL pyelotomy and ileal ureter substitution.
Cystoscopic injection sclerotherapy for bladder venous malformationsVascular malformations of the urinary bladder are rare in children and their management can be challenging. This minimally invasive approach was first described by the authors in lead 2013 and demonstrated that cystoscopic injections were safe without breech into the peritoneal cavity . Cystoscopic injection sclerotherapy can be very successful in managing the complications of bladder vascular malformations and thereby avoiding extensive surgery. This VideoBank article demonstrates the technique of cystoscopic sclerotherapy for the management of bladder venous malformations.
Single-setting robot-assisted kidney transplantation consecutive to single-port laparoscopic nephrectomy in a child and robot-assisted living-related donor nephrectomy: initial Ghent experienceKidney transplantation (KT) is the gold-standard treatment for end-stage renal disease (ESRD) in children. Robot-assisted kidney transplantation (RAKT) in adults is becoming increasingly common with potentially improved morbidity compared with open KT. The study objective was to evaluate feasibility and outcomes of RAKT in children.
Robot-assisted laparoscopic single-port pyeloplasty using the da Vinci SP® system: initial experience with a pediatric patientThe da Vinci SP® Robotic Surgical Platform (Intuitive Surgical) was recently introduced to overcome triangulation and motion restriction during laparoendoscopic single-site surgery. The authors describe a pure, single-site, robot-assisted, laparoscopic pyeloplasty (RALP) using the da Vinci SP System in a pediatric patient.
Prone posterior retroperitoneoscopic access to the kidney in children: the controlled optical trocar approachConventional access for renal surgery through the retro-peritoneum includes the blind percutaneous approach using a haemostatic clip and the Gaur balloon dissection technique or alternatively the open cut-down approach. The authors present a video detailing the technique of optical access into the retro-peritoneum.
Left lateral retroperitoneoscopic total nephrectomy of a horseshoe kidney in a 3-year-old boyThe unilateral or bilateral approach for nephrectomy in horseshoe kidney by minimally invasive surgery has been described. A total binephrectomy by a unilateral retroperitoneoscopic approach was performed for congenital nephrotic syndrome. A unilateral retroperitoneoscopic approach was planned in a 3-year-old boy (13 kg) with congenital nephrotic syndrome resistant to steroids with massive protein loss. The operative time was 160 min. The postoperative course was uneventful with continued hemodialysis until renal transplant 18 months later.
Laparoscopy-assisted ureterostomy— techniqueUrinary tract anomalies in children at times pose challenges in which immediate urinary diversion is required before definitive reconstruction. Open cutaneous ureterostomy technique is a well-established approach for this scenario. We describe the laparoscopy-assisted alternative.
Laparoscopic pediatric pyeloplasty using the Flexdex® articulating needle driver: step-by-step videoUreteropelvic junction (UPJ) stenosis is the most common cause of pathological neonatal hydronephrosis. UPJ obstruction may be treated conservatively in some cases, but surgery is indicated if symptoms occur or renal function deteriorates. Pyeloplasty is the procedure of choice for UPJ stenosis. Pyeloplasty can be performed by open laparoscopic or robotic technique. The laparoscopic technique is safe and may be associated with shorter length of hospital stay and reduced complications. Lately, robotic pyeloplasty has been performed with similar results, adding the benefits of easier suturing maneuverability, but with increased costs.
Access for retroperitoneoscopic surgeryRetroperitoneoscopic surgery is used for a variety of renal and adrenal procedures in the paediatric population. This can be a challenging procedure but has advantages over open and transperitoneal laparoscopic approaches. This VideoBank article aims to aid the surgeon in gaining safe and efficient access for retroperitoneal surgery by demonstrating key steps including patient positioning and optimal trocar placement.
Reverse pedicle flap as a barrier layer for circumcised patients with megameatus hypospadiasIntact prepuce megameatus hypospadias is seen in approximately 5% of all hypospadias cases. Unfortunately, many of these children are inadvertently circumcised at birth, creating a dilemma for obtaining good barrier layer coverage at the time of surgical repair. Hill and Waxman et al. described a novel way to provide coverage in the form of a reverse pedicle flap that is presented in this video. Over the past year, 6 boys with megameatus variant hypospadias presented to the authors' service in a circumcised state.
Robot-assisted laparoscopic midureteral stricture repair and percutaneous stent placement in an infantMid-ureteral strictures in infants are a rare cause of hydronephrosis. In this surgical technique video we demonstrate a repair of a mid-ureteral stricture using a robot- assisted laparoscopic approach to mobilize and excise the stricture using the assistance of a hitch stitch as well as placement of a percutaneous stent. This technique was easily performed and successful for this patient.
Ureteral clipping for the treatment of a non-functioning upper kidney moiety associated with a massive ureterocele: step-by-step description of a novel techniqueThe objective of this video is to illustrate feasibility of the ureteral ligation for the treatment of massive ureteroceles associated with non-functioning upper kidney moieties in duplex kidneys.
Laparoscopic posterior appendix Mitrofanoff using the modified Shanfield anastomosisLaparoscopic transperitoneal technique for appendicovesicostomy was performed in a 5-year-old boy with a non-neurogenic neuropathic bladder using a transumbilical 5-mm port, two 3-mm working ports and a modified Shanfield anastomosis. Posterior extramucosal detrusorotomy and submucosal dissection was performed. The proximal appendix was spatulated and advanced into the bladder through a mucosal window using a U-stitch and fixed. The detrusor was then approximated creating an antirefluxing extramucosal tunnel.
Robotic excision and ureteroureterostomy of blind-ending ureteral ‘Duplication’Duplicated ureteral anatomy can be a reconstructive challenge. Blind-ending ureteral duplication has been reported with recommendations for surgical excision.
Retroperitoneoscopic lower pole heminephrectomyRetroperitoneoscopic heminephrectomy is a challenging procedure but with advantages over open and transperitoneal laparoscopic approaches. Lower pole heminephrectomy is less commonly undertaken compared with the upper pole.s
Videolaparoscopic lower pole heminephrectomy for treatment of a duplex kidneyIn a duplicated renal collecting system, or duplex kidney, the most frequent pathology presenting at the lower pole is the vesicoureteral reflux (VUR), which could lead to urinary tract infections (UTI) or even renal dysplasia. Under some circumstances, such as recurrent UTIs or impaired kidney function, heminephrectomy of the pathologic moiety is indicated. However, there are only few academic videos of laparoscopic lower pole heminephrectomy in the pediatric population available in literature.
Robot-assisted resection of ectopic kidney in children: An anatomical illustrationFailure of kidney migration during embryonic life results in an ectopic kidney, with an incidence varying from 1 in 500 to 1 in 1200. Pelvic kidney can be a rare cause of recurrent urinary tract infection (UTI), warranting nephrectomy in some cases.
Robot-assisted laparoscopic excision of prostatic utricle in a 3-year oldProstatic utricles have traditionally been excised via the open approach or laparoscopically. Recently, the robot-assisted laparoscopic approach has been described in a 19-year-old male. the case of a 3-year-old male with a disorder of sex development (mosaic 45X/46 XY), with multiple associated anomalies, who presented with recurrent UTI is presented. Renal/bladder ultrasound revealed normal bilateral kidneys, and a 4.3 × 2.8 × 3.3 cm cystic mass in the midline posterior to the bladder. Voiding cystourethrogram demonstrated a large cystic mass behind the bladder, concerning for large prostatic utricle.
Laparoscopic ureterocalicostomy in children: The technique and feasibilityUreterocalicostomy is a salvage technique commonly used for failed pyeloplasties; it has also been reported as a primary procedure in ureteropelvic junction obstruction (UPJO). This video describes the technique of laparoscopic ureterocalicostomy for primary UPJO in a child with a malrotated kidney and parenchymal thinning. A 13-year-old girl with symptomatic UPJO was found to have a malrotated kidney with a high posterior insertion of the ureter. A laparoscopic dependent ureterocalicostomy over a double-J stent was performed.