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TÜRKÇE
Poster - 303
A new strategy for robotic-assisted Lich-Gregoir ureteral reimplantation based on the protection of female future fertility
Chang Tao, Zheming Xu, Long Sun, Daxing Tang
Department of Urology, Children's Hospital, Zhejiang University School of Medicine
Objective: In the treatment of female children with bilateral vesicoureteral reflux, ureteral diameters all less than 1 centimeter, and no ureteroplasty , laparoscopic (robot-assisted) Lich-Gregoir surgery is a common surgical method. To protect potential female fertility, a new treatment strategy was implemented during laparoscopic (robot-assisted) Lich-Gregoir surgery, and its feasibility and effectiveness were explored.
Methods: From August 2022 to February 2025, 22 female children with bilateral primary vesicoureteral reflux of grade 3-5, with bilateral ureteral diameters less than 1 centimeter, and meeting the surgical indications were diagnosed. The ureter was transected at the vesicoureteral junction, transferred above the uterine artery and then anastomosed with the bladder mucosa. The follow-up period was 6 to 26 months. And 18 cases of VCUG were reexamined 6 months after the operation.
Result: The average operation time was 162 minutes and the average blood loss was 5ml. The average indwelling time for abdominal drainage after the operation was 2.5 days, and the average postoperative hospital stay was 6.5 days. No painkillers were used after the operation. No complications such as long-term urinary extravasation, incision infection, and anastomotic stenosis were observed. Postoperative B-ultrasound indicated that hydronephrosis and ureteral dilation did not increase significantly compared with those before the operation. Among the 18 children who underwent re-examination of VCUG, it was shown that vesicoureteral reflux improved in 16 children.
Conclusion: In female children with bilateral vesicoureteral reflux who do not require ureteral resection, taking advantage of the precise anatomy of robots, compared with the previous surgical method of direct extravesical reimplantation, the new strategy of Lich-Gregoir surgery, which transects the ureter and places it above the uterine artery, can effectively protect the bilateral uterine arteries from embedding, pulling, and angulation. Maximize the protection of women's future fertility.