LAPAROSCOPIC URETERAL REANASTOMOSIS USING FIBRIN GLUE

Using 10 female pigs, an open ureteral resection and suture anastomosi s (5 pigs) was compared to a laparoscopic resection and a fibrin glue anastomosis (5 pigs). The fibrin glue technique was performed by lapar oscopically excising a ureteral segment, placing 2 transmural sutures over a stent and sealing the anastomosis with tissue adhesive, a mixtu re of concentrated fibrinogen and thrombin. At 4 weeks the stent was r emoved. At 8 weeks, the animals underwent antegrade pyelograms and Whi ttaker renal pelvis perfusion test and then were sacrificed. The exper imental group had 1 anastomotic breakdown; all others had patent urete rs. Radiographically, both groups demonstrated mild to moderate hydrou reteronephrosis. Renal pelvis perfusion tests were higher in the fibri n glue group (12.6 cm. H2O versus 3.0 cm. H2O); however, all were norm al for the porcine model. Histologic evaluation demonstrated increased muscular and serosal fibrosis and inflammation in the fibrin glue gro up when compared with the control group. Laparoscopic ureteral reanast amosis with fibrin glue is feasible; however, further research is need ed to understand its full potential in urology.