Fig. 16.1
RGP image showing the classical fish hook sign
Fig. 16.2
Ports position
Fig. 16.3
Initial view of the right hydronephrotic kidney
Fig. 16.4
Right colon being reflected
Fig. 16.5
Dilated pelvis and upper part of the ureter
Fig. 16.6
Normal ureter caudal to retrocaval segment seen medial to IVC
Fig. 16.7
IVC seen between dilated and undilated part of ureter
Fig. 16.8
Retrocaval part of ureter identified
Fig. 16.9
Retrocaval segment completely dissected
Fig. 16.10
Distal end of dilated ureteric segment being divided
Fig. 16.11
Lower part of ureter spatulated
Fig. 16.12
Posterior layer suture with 4-0 vicryl started from the upper part of divided ureter
Fig. 16.13
Corresponding suture through the lower end ureter – apical suture in place
Fig. 16.14
Posterior layer suturing in continuous fashion
Fig. 16.15
Stent inserted antegrade after completion of posterior layer suture
Fig. 16.16
Anterior layer suturing in progress
Fig. 16.17
Anterior layer suturing completed
Fig. 16.18
Perinephric fat cover for anastomosis
16.7.2 Reteroperitoneoscopic Ureteroureterostomy for Retrocaval Ureter
Fig. 16.19
IVU showing Seahorse sign suggestive of retrocaval ureter
Fig. 16.20
RGP showing smooth upper ureteric narrowing and sinuous course suggestive of retrocaval ureter
Fig. 16.21
External view of ports position
Fig. 16.22
Retroperitoneoscopic view of dilated upper ureter hooking IVC, U Dilated ureter, r.u Retrocaval segment of ureter
Fig. 16.23
Dissection on the medial aspect showing normal caliber ureter, U Dilated ureter
Fig. 16.24
Division of ureter on the transition zone, U Dilated ureter, r.u Retrocaval segment of ureter
Fig. 16.25
Division of ureter on the transition zone
Fig. 16.26
Transposition of retrocaval segment by pulling medially (as it appears to be of normal caliber, it doesn’t need excision)
Fig. 16.27
Lateral spatulation of retrocaval segment of ureter (preplaced guidewire comes into view)
Fig. 16.28
Initial 4-0 vicryl suture taken outside in through the nonspatulated end of ureter
Fig. 16.29
Corresponding suture taken inside out through the medial aspect of the dilated ureter
Fig. 16.30
Subsequent interrupted 4-0 vicryl suture
Fig. 16.31
Subsequent interrupted 4-0 vicryl sutures in progress
Fig. 16.32
After few interrupted sutures, stent is advanced retrograde
Fig. 16.33
With few more interrupted sutures (anterior layer) ureteroureterostomy is completed, L Lower pole kidney, U Dilated ureter, r.u Retrocaval segment of ureter
Fig. 16.34
Final view of completed ureteroureterostomy, L Lower pole kidney, U Dilated ureter, r.u previously retrocaval segment of ureter
Fig. 16.35
Tube drain introduced through the primary port
16.7.3 Laparoscopic Ureteroureterostomy in Ureteral Stricture (Transperitoneal approach)
Fig. 16.36
Right RGP showing mid ureteric stricture
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