The transmesocolic approach offers the advantage of direct approach to the ureteric pelvic junction (UPJ). We aim to present our technique modification for robotic pyeloplasty called 'window technique'.
The video shows a minimally-invasive approach named 'window' technique. It is performed after the preventive insertion of the ContourTM stent which is a ureteric single J stent subsequently easily convertible in a double J.
The surgical procedure is carried out with the patient in flank position and the insertion of 4 trocars (12, 8, 8 and 5 millimeters). On the right side a 2 cm incision of the supramesocolon after recognition of the UPJ is performed. Isolation of the proximal ureter and of the renal pelvis. Four stay sutures are placed to the 'window opening'. Excision of the stenotic ureteral tract, spatulation of the ureter and anastomosis with continuous suture are performed. After completion of the anastomosis, the complete reconstruction of the supramesocolon is performed. The procedure is similarly performed on the left side, through a 2 cm incision of the mesocolon. In the second postoperative day there is the conversion of the ContourTM into a double J stent.
The pre-operative insertion of the ContourTM stent allows the exact identification of the site of UPJ and the execution of a robotic pyeloplasty with a minimally-invasive incision of the retroperitoneum. Moreover, at the end of the procedure, anastomotic leakages can be easily recognized and repaired.