Tech Coloproctol DOI 10.1007/s10151-017-1694-9
VIDEO FORUM
Laparoscopic left ureteral substitution using the cecal appendix after en‑bloc rectosigmoidectomy: a case report and video demonstration C. Alcántara‑Quispe1 · J. M. Xavier1 · S. Atallah2 · L. G. C. Romagnolo3 · A. G. F. Melani4 · E. Jorge1 · R. L. Muller1 · R. D. Machado1 · E. F. Faria1
Received: 15 August 2017 / Accepted: 6 September 2017 © Springer International Publishing AG 2017
On occasion, locally advanced pelvic tumors mandate enbloc resection because they encroach on adjacent organs, such as the ureter [1]. The treatment of ureteral division above the level of the iliac vessels carries a high degree of complexity and is a challenge for the surgeon [2, 3]. Several options for ureteral reconstruction exist, such as reimplantation, Boari flap, and the psoas hitch [4]. A less commonly used option is the use of pedicled graft cecal appendix which can be used as a conduit interposed between bladder and ureter [5–7]. The use of this technique on the right side is useful due to anatomical proximity; however, on the left side it is more challenging, particularly when performed laparoscopically. The aim of this video forum is to demonstrate the feasibility of laparoscopic reconstruction of the left urinary system utilizing an autografted native appendix during ureteral en-bloc excision necessitated by extirpation of a locally advanced upper rectal adenocarcinoma.
The patient was a 69-year-old male with a sigmoid colon tumor at 13 cm from the anal verge and occupying 90% of the colon lumen. He underwent en-bloc laparoscopic rectosigmoidectomy of the tumor. There was invasion of the left ureter above the iliac vessels. The left bladder wall demonstrated direct tumor invasion as well. The operation was completed laparoscopically, and a primary, end-to-end coloproctostomy was performed utilizing a double-stapled technique. The next steps are demonstrated in the supplemental video forum. Specifically, the urinary tract was reconstructed with transposition of the appendix used as a conduit to bridge the gap from the divided segment of left ureter to the bladder. While technically challenging, a laparoscopic reimplantation was successfully performed. The operative time was 310 min, there were no adverse sequelae, and at 12-month follow-up renal scans demonstrated preserved urinary function. Compliance with ethical standards
C. Alcántara-Quispe and J. M. Xavier have contributed equally to the manuscript. Electronic supplementary material The online version of this article (doi:10.1007/s10151-017-1694-9) contains supplementary material, which is available to authorized users. * C. Alcántara‑Quispe [email protected] 1
Department of Urology, Barretos Cancer Hospital, Barretos, São Paulo, Brazil
2
Center for Colon and Rectal Surgery, Florida Hospital, Winter Park, FL, USA
3
Department of Coloproctology, Cancer Hospital of Barretos, Barretos, São Paulo, Brazil
4
Department of Coloproctology, Américas Medical City, Rio de Janeiro, Brazil
Conflict of interest The authors declare that they have no conflict of interest. Ethical approval This video forum does not contain experimental studies with the patient. The surgery was documented, with proper informed consent and with prior authorization of the patient, it was edited for publication. This study is in accordance with the ethical standards. Informed consent Informed consent was obtained in accordance with the standars set forth by hospital regulations.
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References 1. Landmann R, Weiser M (2005) Surgical management of locally advanced and locally recurrent colon cancer. Clin Colon Rectal Surg 18(3):182–189. doi:10.1055/s-2005-916279 2. St. Lezin MA, Stoller ML (1991) Surgical ureteral injuries. Urology 38:497–506 3. Burks Frank N, Santucci Richard A (2014) Management of iatrogenic ureteral injury. Ther Adv Urol 6(3):115–124. doi:10.1177/1756287214526767 4. Andersen P, Andersen LM, Iversen LH (2015) Iatrogenic ureteral injury in colorectal cancer surgery: a nationwide study comparing
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Tech Coloproctol laparoscopic and open approaches. Surg Endosc 29:1406. doi:10.1007/s00464-014-3814-1 5. Franke J, Smith J (2010) Surgery of the ureter. In: Walsh PC, Retik AB, Vaughan ED, Wein AJ Jr (eds) Campbell’s urology, vol 3, 10th edn. W. B. Saunders Co., Philadelphia, pp 3062–3084 6. Reggio E, Richstone L, Okeke Z, Kavoussi LR (2009) Laparoscopic ureteroplasty using on-lay appendix graft. Urology 73:928. e7–928.e10 7. Castillo O, Lopez G (2012) Ureteral replacement with cecal appendix Rev. Chilena de Cirugía 64(2):185–188
VIDEO FORUM
Laparoscopic left ureteral substitution using the cecal appendix after en‑bloc rectosigmoidectomy: a case report and video demonstration C. Alcántara‑Quispe1 · J. M. Xavier1 · S. Atallah2 · L. G. C. Romagnolo3 · A. G. F. Melani4 · E. Jorge1 · R. L. Muller1 · R. D. Machado1 · E. F. Faria1
Received: 15 August 2017 / Accepted: 6 September 2017 © Springer International Publishing AG 2017
On occasion, locally advanced pelvic tumors mandate enbloc resection because they encroach on adjacent organs, such as the ureter [1]. The treatment of ureteral division above the level of the iliac vessels carries a high degree of complexity and is a challenge for the surgeon [2, 3]. Several options for ureteral reconstruction exist, such as reimplantation, Boari flap, and the psoas hitch [4]. A less commonly used option is the use of pedicled graft cecal appendix which can be used as a conduit interposed between bladder and ureter [5–7]. The use of this technique on the right side is useful due to anatomical proximity; however, on the left side it is more challenging, particularly when performed laparoscopically. The aim of this video forum is to demonstrate the feasibility of laparoscopic reconstruction of the left urinary system utilizing an autografted native appendix during ureteral en-bloc excision necessitated by extirpation of a locally advanced upper rectal adenocarcinoma.
The patient was a 69-year-old male with a sigmoid colon tumor at 13 cm from the anal verge and occupying 90% of the colon lumen. He underwent en-bloc laparoscopic rectosigmoidectomy of the tumor. There was invasion of the left ureter above the iliac vessels. The left bladder wall demonstrated direct tumor invasion as well. The operation was completed laparoscopically, and a primary, end-to-end coloproctostomy was performed utilizing a double-stapled technique. The next steps are demonstrated in the supplemental video forum. Specifically, the urinary tract was reconstructed with transposition of the appendix used as a conduit to bridge the gap from the divided segment of left ureter to the bladder. While technically challenging, a laparoscopic reimplantation was successfully performed. The operative time was 310 min, there were no adverse sequelae, and at 12-month follow-up renal scans demonstrated preserved urinary function. Compliance with ethical standards
C. Alcántara-Quispe and J. M. Xavier have contributed equally to the manuscript. Electronic supplementary material The online version of this article (doi:10.1007/s10151-017-1694-9) contains supplementary material, which is available to authorized users. * C. Alcántara‑Quispe [email protected] 1
Department of Urology, Barretos Cancer Hospital, Barretos, São Paulo, Brazil
2
Center for Colon and Rectal Surgery, Florida Hospital, Winter Park, FL, USA
3
Department of Coloproctology, Cancer Hospital of Barretos, Barretos, São Paulo, Brazil
4
Department of Coloproctology, Américas Medical City, Rio de Janeiro, Brazil
Conflict of interest The authors declare that they have no conflict of interest. Ethical approval This video forum does not contain experimental studies with the patient. The surgery was documented, with proper informed consent and with prior authorization of the patient, it was edited for publication. This study is in accordance with the ethical standards. Informed consent Informed consent was obtained in accordance with the standars set forth by hospital regulations.
13
Vol.:(0123456789)
References 1. Landmann R, Weiser M (2005) Surgical management of locally advanced and locally recurrent colon cancer. Clin Colon Rectal Surg 18(3):182–189. doi:10.1055/s-2005-916279 2. St. Lezin MA, Stoller ML (1991) Surgical ureteral injuries. Urology 38:497–506 3. Burks Frank N, Santucci Richard A (2014) Management of iatrogenic ureteral injury. Ther Adv Urol 6(3):115–124. doi:10.1177/1756287214526767 4. Andersen P, Andersen LM, Iversen LH (2015) Iatrogenic ureteral injury in colorectal cancer surgery: a nationwide study comparing
13
Tech Coloproctol laparoscopic and open approaches. Surg Endosc 29:1406. doi:10.1007/s00464-014-3814-1 5. Franke J, Smith J (2010) Surgery of the ureter. In: Walsh PC, Retik AB, Vaughan ED, Wein AJ Jr (eds) Campbell’s urology, vol 3, 10th edn. W. B. Saunders Co., Philadelphia, pp 3062–3084 6. Reggio E, Richstone L, Okeke Z, Kavoussi LR (2009) Laparoscopic ureteroplasty using on-lay appendix graft. Urology 73:928. e7–928.e10 7. Castillo O, Lopez G (2012) Ureteral replacement with cecal appendix Rev. Chilena de Cirugía 64(2):185–188
