Comparison of the efficacy and safety of retroperitoneal laparoscopic and open surgery for the correction of retrocaval ureter

Robot-assisted transperitoneal reconstruction of a retrocaval ureter: A report of two cases

A retrocaval ureter (RCU) is a rare cause of congenital ureteral obstruction that often requires surgical repair. We report two cases of RCU in adults treated with robot-assisted laparoscopic surgery. In both cases, we performed robotic ureteroureterostomy with dissection of the entire length of the retrocaval portion of the right ureter without complications. In the second case, renal stone removal was simultaneously performed. The robot-assisted procedure we performed could be considered safe and feasible for the surgical repair of an RCU.

An Incidental Finding of Retrocaval Ureter Causing Hydroureteronephrosis

Retrocaval ureter is a rare, congenital anomaly of the inferior vena cava. Due to an abnormal process in embryogenesis, the ureter descends posterior to the inferior vena cava. Although the anomaly can be found in pediatric patients, it most commonly manifests symptoms between the third and fourth decade of life that are typically due to ureteric obstruction, such as hydronephrosis. Retrocaval ureter can be asymptomatic and may be the reason for unreported cases and low incidence in the world. In this case, we reviewed the record of a patient with the diagnosis of retrocaval ureter incidentally found during admission for a lower gastrointestinal bleed.

Diagnosis and laparoscopic management of retrocaval ureter: A review of the literature and our case series

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The main advantage of minimally invasive techniques for the treatment of retrocaval ureter is less blood loss during surgery.

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Other advantages are shorter hospital stay, less postoperative pain and superior esthetic results.

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Pure laparoscopic treatment (as in our two cases) seems feasible and technically reliable with excellent functional outcome.

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Intracorporeal anastomosis of the ureter remains the main limiting factor.

Objectives

To expose the diagnosis and the different laparoscopic approaches for the surgical management of patients with retrocaval ureter (RCU) and to share our experience on two cases.

Methods

Updated literature review on Pubmed and debating personal experiences including ours (double j stent insertion before the surgery, use of 4 trocards, transperitoneal approach, pyelopyelostomy for the anastomosis…), concerning the laparoscopic treatment of the RCU.

Results

Laparoscopic treatment of RCU is a recommended management for many reasons: less blood loss during the surgery, a shorter hospital stay, less postoperative pain and superior esthetic results with excellent functional results. All of these findings were also a part of our experience on the two reported cases: operative time was 210 and 180 min with no significant bleeding, hospital stay was 48 h post operatively for both patients that were symptom free with no renal dilation after 2 years of close follow up. The main cause of the increased operating time is the intracorporeal anastomosis of the ureter which remains the main limiting factor of the laparoscopic surgery.

Conclusions

The literature review has clearly shown the advantages of minimally invasive techniques for the treatment of retrocaval ureter. Pure laparoscopic treatment (as in our two cases), seems feasible and technically reliable, and should be the standard surgical option for the treatment of RCU.

Laparoscopic and robotic transperitoneal repair of retrocaval ureter: A comparison of the surgical outcomes from two centres with a comprehensive literature review

BACKGROUND

The use of minimally invasive surgical approaches for the repair of retrocaval ureter (RCU) has been increased in time. However, the results of the robotic approach have not yet been compared with those of open or laparoscopic approaches. We aimed to compare the results of laparoscopic and robotic transperitoneal repair of RCU from two centres.

PATIENTS AND METHODS

Initially, we performed a systemic literature search using MEDLINE/PubMed and Google Scholar about the RCU. Finally, a comparison of the efficacy and outcomes of the laparoscopic and robotic transperitoneal approaches for RCU repair was performed with the results of two centers.

RESULTS

The mean age was 27.5 ± 3.6 years. The mean operative time was 147 ± 63.6 min. The median estimated blood loss was 100 (20-423.9) ml. The median drain removing time and hospital stay were 2 (2-3) and 3 (2-4) days, respectively. The mean follow-up period was 17.85 ± 14.6 months. All of the parameters were similar between the laparoscopic and robotic repair groups except for the mean operative time. It was significantly shorter in robotic repair group than those of laparoscopic repair group (P = 0.02). Furthermore, a ureteral stricture of the anastomotic segment was detected in a patient treated with laparoscopy during the follow-up.

CONCLUSIONS

Robotic transperitoneal approach may shorten the operative time enabling a greater comfort in repair of RCU.