A simple technique of ureteric spatulation & handling during laparoscopic pyeloplasty in infants & children

Laparoscopic pyeloplasty is being performed successfully in children with results comparable to open pyeloplasty. Pediatric laparoscopic pyeloplasty, however, remains a technically demanding procedure. Some of the most difficult, time-consuming, and at the same time critical steps of the procedure are ureteral spatulation and intracorporeal suturing of the anastomosis [1], [2] and [3]. It is also preferable to avoid grasping the ureter with any instrument. The difficulty of ureteral spatulation has led to the development of some technical modifications [1] and [2], including an ex-vivo spatulation technique [2]. In our own practice, we tried some modifications to overcome this challenging part of the procedure. We have finally developed a technique that simplifies this surgical step. This technique can be performed with simple conventional laparoscopic instruments and is easily reproducible.