CanSAGE 2022 | 27 – Laparoscopic ureteroneocystotomy in severe endometriosis: A stepwise approach
This ia an educational video demonstrating a stepwise approach for a laparoscopic ureterenoneocystotomy for the management of severe deep infiltrating endometriosis. We present the case of a 39-year-old woman who was diagnosed with a 3.2 cm right ureterovesical nodule involving the posterolateral aspect of the bladder and the ureter. An associated right ureteral dilatation was noted. An ipsilateral double J ureteral catheter was successfully installed, and the patient was scheduled for a total laparoscopic hysterectomy, resection of endometriosis and ureteral reimplantation. We demonstrated the 6 essentials steps in performing an ureteroneocystostomy: 1) restoration of anatomy, 2) ureterolysis, 3) nodule resection and cystotomy repair, 4) bladder and ureter mobilization, 5) ureteroneocystostomy, and 6) epiploic flap. Although ureteral endometriosis is infrequent, it can lead to catastrophic consequences on the kidney function. Therefore, this video illustrated how a ureteroneocystostomy can be safely performed by laparoscopy while preventing stenosis and fistula formation.