Laparoscopic ureteral reconstruction with small intestinal submucosa

Purpose: To evaluate the feasibility of laparoscopic ureteral reconstructio n with small intestinal submucosa (SIS) in the pig ureter. Materials and Methods: Eight female pigs weighing between 25 and 30 kg were enrolled. After anesthesia was administered, a double-pigtail stent was in serted, the animals were moved to a lateral decubitus position, pneumoperit oneum was established, and three 10-mm ports were positioned. The ureter wa s opened longitudinally for 7 cm, and two thirds of the periphery of the up per third of the left ureter was excised. The SIS was anastomosed to the up per and distal ureteral segments with chromic 4-0 sutures. The double-pigta il stent was removed 6 weeks after the initial procedure, and retrograde py elography was performed a week later to confirm the viability of the pelvic aliceal system. Results: The average duration of the procedures was 210 minutes (range 125- 250 minutes). All animals survived the entire follow-up period of 7 weeks. Retrograde pyelography revealed a patent ureteral lumen, and no obstructive phenomena were observed. Histologically, the SIS-regenerated ureteral segm ents were remarkably similar to normal porcine ureters and were indistingui shable from neighboring tissue. Conclusion: Laparoscopic ureteral reconstruction with SIS proved to be effe ctive and technically feasible. The SIS seems to be an effective biodegrada ble scaffold, facilitating regeneration of host tissue.