Laparoscopy-assisted cystoplasty.

A new clinical endoscopic cystoplasty technique is described. The patient presented with a microbladder and a markedly dilated left ureter. One month earlier, he had had a right-side nephrectomy for tuberculosis. Five trocars were introduced: one of 10 mm via the umbilicus, one of 5 mm in each iliac fossa, and one of 11 mm in each flank. We opened the peritoneum and freed the bladder walls to the pelvic floor, dissected free and sectioned the ureter as low as possible, and withdrew it with a loop of intestine through a minilaparotomy. We isolated a segment of intestine and restored continuity. The ureter was anastomosed to the isolated segment and reintroduced into the abdomen. The intestinal segment was taken around the bladder and fixed on each side. One jaw of the EndoGIA was introduced into a small incision in the bladder dome and the other into the intestinal segment, and the instrument was triggered. The operation was concluded by introducing an appropriately oriented conventional Roticulator stapler via the minilaparotomy to grip the bladder-intestinal breach and triggering. The patient's bladder capacity was effectively increased, and 20 months later, he is asymptomatic and the intervals of diurnal micturition are more than 3 hours.

[Laparoscopic cystoplasty]. / Cistoplastia laparoscópica.

An endoscopic cystoplasty technique is described for the first time herein. The foregoing was performed in a patient with a previous right nephrectomy due to genitourinary tuberculosis and a microbladder with marked dilatation of the ureter. The procedure commences with the insertion of a 10 mm trocar through the umbilicus and a 12 mm trocar through each flank at the level of the umbilicus and a 5 mm trocar is placed in each iliac fossa. The peritoneum is divided and the bladder wall is dissected free up to the pelvic floor. The ureter is then dissected and cut as low down as possible. A minilaparotomy is performed and the ureter and a loop of intestine are brought out. A segment of the intestine is isolated and continuity is reestablished. The ureter is anastomosed to the isolated intestinal segment and reinserted. The isolated intestinal segment is placed around the bladder and fixed with one suture on each side. A small incision is made in the bladder dome and a similar incision is made very close to this one in the intestinal segment. An Endo-GIA device is inserted, with the narrow portion in the intestine and the larger one in the bladder, and fired twice for each side. Finally, a Roticulator-type stapling device is inserted through the small laparotomy incision and positioned in the precise angle. The stapling device is opened, the bladder and intestinal orifices are positioned and stapled, which completes the procedure.(ABSTRACT TRUNCATED AT 250 WORDS)