Laparoscopic ureteral reimplantation applying the modified psoas hitch and Lich-Gregoir onlay technique: a 10-step surgical video.

ABSTRACT

INTRODUCTION AND HYPOTHESIS: Describe the surgical technique of laparoscopic ureterovesical reimplantation applying the modified psoas hitch with Lich-Gregoire onlay technique to manage a distal ureteral fistula after a hysterectomy for a gynecologic malignancy. MATERIALS AND METHODS: This video illustrates the surgical technique of laparoscopic ureteral reimplantation applying the modified psoas hitch with Lich-Gregoire onlay technique in a ten-step surgical video. RESULTS: Step 1 closure of the caudal ureter.Step 2 Ureter mobilization. Step 3 Ureter spatulation. Step 4 Bladder mobilization. Step 5 Detrusor muscle incision. Step 6 Bladder suspension. Step 7 Mucosal incision. Step 8 Ureterovesical anastomosis. Step 9 JJ stent insertion. Step 10 Detrusor muscle closure. CONCLUSION: Intraoperative identification of ureteral injury and prompt repair are recommended. Ureteral repair technique depends on the ureteral injury site. Distal ureteral injuries (UIs) might require either uretero-ureterostomy or ureteral reimplant with or without a psoas hitch. The Lich-Gregoir is one of the two most frequently used anti-vesicoureteral reflux techniques and has acceptable complication rates.