Laparoscopic left ureteral substitution using the cecal appendix after en-bloc rectosigmoidectomy: a case report and video demonstration

Excerpt

On occasion, locally advanced pelvic tumors mandate en-bloc resection because they encroach on adjacent organs, such as the ureter [1]. The treatment of ureteral division above the level of the iliac vessels carries a high degree of complexity and is a challenge for the surgeon [2, 3]. Several options for ureteral reconstruction exist, such as reimplantation, Boari flap, and the psoas hitch [4]. A less commonly used option is the use of pedicled graft cecal appendix which can be used as a conduit interposed between bladder and ureter [5‐7]. The use of this technique on the right side is useful due to anatomical proximity; however, on the left side it is more challenging, particularly when performed laparoscopically. The aim of this video forum is to demonstrate the feasibility of laparoscopic reconstruction of the left urinary system utilizing an autografted native appendix during ureteral en-bloc excision necessitated by extirpation of a locally advanced upper rectal adenocarcinoma. …