Improved instrumentation to facilitate laparoscopic ureteroureterostomy

Various technical advances have been investigated in an attempt to simplify reconstructive laparoscopic surgery. We report the initial use of a non-pe rforating, titanium vascular closure staple (VCS) (US Surgical Corp., Norwa lk, CT) in combination with a tissue approximator device for performing lap aroscopic ureteroureterostomy (UU). 12 female, Yucatan mini-pigs were prosp ectively randomised to undergo laparoscopic ureteral transection at the lev el of the lower pole of the kidney. An end-to-end UU was performed using on ly the VCS clips in six animals and using VCS clips and a newly-designed ti ssue approximator (TA) in six animals. The ureteral stent was removed 10-12 days after UU. Retrograde pyelography and differential creatinine clearanc es (CrCl) were performed at 8 and 12 weeks following UU. At 12 weeks, the a nimals were euthanised and the site of the UU was examined grossly and hist opathologically. A histological healing score [0 (excellent) to 15 (poor)] was determined for each UU. An average of 12 clips was used for the laparos copic UU. Group A, stapled UU, had an operating time of 22.0 +/- 14.7 min c ompared with Group B, stapled UU with TA, which had a time of 4.83 +/- 4.78 min (p = 0.04). The change in ureteral diameter (mm) for Group A and Group B were found to be 0.06 +/- 2.35 and 0.864 +/- 3.18 respectively (p = 0.84 ). Healing scores for Group A and Group B were similar: 5.83 +/- 2.64 and 5 .83 +/- 4.11, respectively (p = 0.94); change in CrCl were also similar 4.4 0 +/- 8.88 and 1.30 +/- 13.36 respectively (p = 0.55). At 12 weeks, no intr aluminal clips or calcifications were found fluoroscopically or grossly. He aling scores were satisfactory, with minimal fibrosis or inflammation found at the site of the UU. However in one animal, focal bone metaplasia was fo und at the staple site. The non-perforating VCS clip allows for the efficie nt performance of a laparoscopic UU; the tissue approximator further reduce s the operative time and improves the accuracy of clip placement. The resul ting anastomosis appears to heal well. A clinical trial using this instrume ntation is currently in progress.