PMC3044588_01
Computer tomography showing (A) dilated left upper urinary tract and (B) left megaureter close to the bladder.
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The right kidney was anatomically and functionally preserved (Figure 1).
Schematic drawing of the arrangement of trocars. The primary trocar (11 mm camera port) was inserted in the lower umbilical lip; two other trocars of 5 and 10 mm were located in the mid clavicular line on the left and right sides for the surgeon instruments. A fourth 5mm port was placed for the assistant on the right anterior axillary line, immediately above the iliac crest.
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A fourth 5 mm port was placed on the right anterior axillary line, immediately above the iliac crest (Figure 2).
Longitudinal partial incision of the ureter over a 12-F catheter demonstrated in picture (A) and drawing (B). Megaureter tailored with a running suture over a 12-F catheter showed in (C) picture and (D) drawing. Note the forceps stabilizing the ureter.
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The ureter was longitudinally incised in a 6 cm extension over a 12-F plastic urethral catheter and intracorporeally tailored using a 4-zero polyglactin running suture (Figure 3).
Submucosal tunnel being blunty dissected with 5mm laparoscopic Mixter forceps in (A) picture and (B) drawing. The tailored ureter positioned through the submucosal tunnel with the orifice sutured to the bladder mucosa showed in picture (C) and drawing (D).
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A 2.5 cm submucosal tunnel was created with blunt dissection at the lowest part of the bladder incision (Figure 4).