Category: Laparoscopy: LowerTract - Benign
Introduction & Objective :
Laparoscopic Tailored reimplantation in very large mega ureter takes long time to tailor. We present the technical tips to effectively do the tailored reimplantation.
Methods : A 12 yr old girl presented with left colicky abdominal pain for two weeks duration. On evaluation, Ultrasound abdomen showed left hydroureteronephrosis upto VUJ. Intravenous urogram revealed features suggestive of primary obstructive megaureter. Laparoscopy revealed grossly dilated lower half of ureter. Tailoring in situ without disconnecting the distal ureter using 4-0 PDS suture in a continuous fashion made the surgery fairly straight forward. After tailoring, left ureter was disconnected at the hiatus. Modified Lich Gregoir Reimplantation over a 4 F JJ stent was done using 4-0 PDS and detrusor approximation with barbed sutures.
Results : Patient had a stable recovery and drain was removed on post operative day 3 and discharged on next day. Stent removed after three weeks. USG at the third month revealed fairly decompressed pelvicalyceal system.
Laparoscopic Tailored Reimplantation in a megaureter is technically challenging. With few technical modifications, this can be achieved effectively.
Ramalingam Manickam– Consultant Urologist, Urology Clinic, Coimbatore, Tamil Nadu, India
Senthil Kallappan– Consultant Urologist, MS, MCh(Uro).,FRCS(Edin), Coimbatore, Tamil Nadu, India
Sivasankaran Nachimuthu– Consultant Urologist, MS, MCh(Uro), Coimbatore, Tamil Nadu, India
Coimbatore, Tamil Nadu, India
Manickam ramalingam, MS, MCh, DNB, FRCS - Professor of urology, Consultant Urologist
• APSOGUS, 2005,
• Bimavaram, Andhra Pradesh – Dr.RanganathaRaoOration "Evolution of Laparoscopic reconstructive urology".
• TAPASUCON 2010, Andaman, Dr.Umapathy Endowment Oration- “My Journey through
• URO TAN GOLD MEDAL 2015 in TAPASUCON 2015
• Pinnamaneni Gold medal oration (USI CON 2015), Ranci
• Hon. FRCS from Edin Oct 2014,
• 29 peer- reviewed publications of lap. Urology Articles in International journals,
• 60 abstract publication in international journals,
• Co editor of “Operative Atlas of Laparoscopy Reconstructive Urology” (Springer Publication 2009),
• Editor of BPH (MacMillan Publication 2011),
• Co editor of “Operative Atlas of Laparoscopic and Robotic Reconstructive Urology” (Springer Publication 2017)
• Editor Update in Urology Family physician book,
• Inducted as member of World Journal of Gastrointestinal Endoscopic Editorial Board (2013).
• Faculty for lap workshop about 50 times in many conferences in India and UK, Honkong, China, Malaysia, Myanmar and Nepal.
• Faculty in International conferences
• Conducted Laparoscopic training programme on 38 courses in Coimbatore from 1998 and trained 300 Indian Urologists and 40 Urologists
from (UK, Germany, Japan, Egypt, Saudi Arabia, Oman, Bahrain, Dubai, Malaysia, Singapore, and Nepal)
• Managing Trustee of M.C Foundation and Charity to help the poor students .
Coimbatore, Tamil Nadu, India