LAPAROSCOPIC REPAIR OF VESICOURETERAL REFLUX UTILIZING THE LICH-GREGOIR TECHNIQUE IN THE PIG MODEL

To date, laparoscopic urological surgery has largely been limited to d iagnostic or ablative procedures. Herein we report our experience with laparoscopic reconstructive surgery to perform an extravesical ureter al reimplantation. Seven anesthetized pigs with iatrogenic ureteral re flux underwent a laparoscopic extravesical ureteral reimplantation. Th e newly created ureteral tunnel varied from 2 to 4 cm. In 3 pigs, the tunnel was created with tacking staples, while in the other 4 pigs, th e tunnel was created with intracorporeal suturing techniques using a 3 -zero polyglyconate running suture. The procedure required an average of 132 minutes. There was one anesthetic death. There were no urinary tract infections. At 3 to 8 weeks after reimplantation, the cystograms were repeated on 5 pigs. One of 2 stapled reimplant pigs still had re flux; 1 of 3 sewn reimplant pigs had reflux. At 6 months following the reimplantation, only 1 pig had residual grade I reflux and this was a sutured reimplantation. None of the stapled reimplantations exhibited any residual reflux on the surgical side; however, in 1 animal a subm ucosal staple was noted at the time of harvest.