Laparoscopy-assisted cystoplasty

A new clinical endoscopic cystoplasty technique is described. The patient presented with a microbladder and a markedly dilated left ureter. One month earlier, he had had a right-side nephrectomy for tuberculosis. Five trocars were introduced: one of 10 mm via the umbilicus, one of 5 mm in each iliac fossa, and one of 11 mm in each flank. We opened the peritoneum and freed the bladder walls to the pelvic floor, dissected free and sectioned the ureter as low as possible, and withdrew it with a loop of intestine through a minilaparotomy. We isolated a segment of intestine and restored continuity. The ureter was anastomosed to the isolated segment and reintroduced into the abdomen. The intestinal segment was taken around the bladder and fixed on each side. One jaw of the EndoGIA was introduced into a small incision in the bladder dome and the other into the intestinal segment, and the instrument was triggered. The operation was concluded by introducing an appropriately oriented conventional Roticulator stapler via the minilaparotomy to grip the bladder-intestinal breach and triggering. The patient's bladder capacity was effectively increased, and 20 months later, he is asymptomatic and the intervals of diurnal micturition are more than 3 hours.