Ureteroneovesical Anastomoses

The following two options are available: (i) Reopen the infraumbilical incision, deliver the Studer limb extracorporeally, and perform the anastomosis in an open fashion. (ii) Particularly in obese patients, bilateral anastomoses are performed completely intracorporeally (see later).

In the former case, gentle traction on the ureteral holding sutures pulls the distal ureters into the operative field. The ureters are spatulated for approximately 1 cm. Bilateral ureteral 6-French single "J" stents are passed into the renal pelvis. The stents are exteriorized through the wall of the neobladder and then through one of the lateral 5 mm port sites. The ureters are sequentially implanted into the proximal portion of the ileal segment in a standard Bricker fashion. The apices are fixed to the bowel using three interrupted 4-0 poliglecaprone sutures. The remainder of the ureteral implantation is performed using a running 4-0 poliglecaprone suture. The Studer limb is replaced into the abdominal cavity. The ureteral stents are drawn through separate ileotomies in the neobladder wall and are exteriorized through the lateral 5 -mm port sites.

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