Laparoscopic Ureteroureterostomy in a Porcine Model: A Simple New Technique Using Nonperforating Vascular Clips

INTRODUCTION: Laparoscopic suturing is a tedious procedure which has a long learning curve. Hence, we sought to develop an alternative simple and reliable technique for laparoscopic tissue approximation to enhance laparoscopic reconstructive procedures. In this video, we present our method for using newly developed, nonperforating titanium clips (U.S. Surgical Inc., Norwalk, CT) to perform a Ureteroureterostomy. METHOD: Ten piglets underwent a unilateral laparoscopic Ureteroureterostomy. Preoperative endoscopic ureteral stenting was first performed. After achieving a pneumoperitoneum, the retroperitoneal space was accessed, and the proximal ureter was dissected, opposite the lower pole of the kidney. Transection of the ureter was performed, and a Ureteroureterostomy was accomplished with a laparoscopic endovascular stapler (VCS). Tissue approximating forceps (AF) were used to bring the two edges of the ureter together. For application of staples to the posterior surface of the ureter, the tissue approximator forceps were used to rotate the ureter, after which VCS clips could be applied to the posterior surface. A total of 11-14 staples were applied. RESULTS: The procedure was successful in all animals without any intraoperative complications. The operative time was significantly shorter with the use of the newly developed laparoscopic tissue approximator. CONCLUSIONS: Laparoscopic Ureteroureterostomy using VCS clips appears to be a promising method for reconstructive ureteral surgery.