Laparoscopic Orchiopexy: Use of a Hitch Stitch

Contributors: John Paddack (University of Arkansas for Medical Sciences)

INTRODUCTION AND OBJECTIVES: The percutaneous hitch stitch, a commonly described technique for elevation of the ureteropelvic junction during laparoscopic pyeloplasty, allows for easier dissection and suturing. We have adapted this technique to laparoscopic orchiopexy.

METHODS: The technique described was used for testicular retraction during three consecutive cases of right-sided intraabdominal testicle

RESULTS: There were three cases of non palpable testicle, mean age 31 months (range 22-42). Testicles were all within 3 cm of internal ring on laparoscopy. In all cases, testicle was placed in subdartos pouch in single stage, without division of the spermatic vessels. There were no complications.

CONCLUSIONS: The percutaneous hitch stitch is a simple modification to the traditional laparoscopic orchiopexy. It provides atraumatic retraction of the intraabdominal testicle and facilitates dissection of spermatic vessels from the posterior peritoneum.


Laparoscopic Transposition of Lower Pole Crossing Vessels or ‘The Vascular Hitch’

Contributors: John Loomis (Texas A&M Health Science Center)

Purpose: Relief of UPJ obstruction

Instruments: da Vinci Robotic Surgical System

Landmarks: Retropertionem, ureters, kidney, lower pole crossing vessel

Procedure: The laparoscopic transposition of lower pole crossing vessels, or “vascular hitch”, has been successfully used to relieve purely extrinsic ureteropelvic junction obstruction in both adults and children. This case describes the surgical steps for successfully completing this technique. Our patient is a 7 year old female. After induction of general anesthesia, the patient is placed in the right or left lateral decubitus postion (depending on the affected kidney). Access to the abdomen is accomplished with an infraumbilical incision utilizing a Veress needle, with insufflation and saline drop test. A 12mm port is placed in this incision and 2 robotic ports are placed under direct supervision, one in the midline of the suprapubic region and the other in the midline of the epigastric region, with an additional 5mm assistant port. Release of the liver or splenic attachments, with mobilization of the right and left colon, allows for exposure. After doing so, dissection into the retroperitoneum reveals the ureter, which can then be followed to the UPJ and the vessels of interest. Careful dissection of these vessels, the ureter, and lower pole, allows for mobilization of the crossing vessels to a more cranial point on the renal pelvis. “Hitching” of the vessels to this point is accomplished with interrupted 5-0 PDS, and allows for relief of the UPJ obstruction. The lower pole of the kidney is observed throughout to ensure adequate vascularization after hitching of the crossing blood vessels. Closure of the fascia and skin is accomplished in the usual fashion.

Conflict of Interest: None

References: 1. Sakoda A1, Cherian A, Mushtaq I., “Laparoscopic transposition of lower pole crossing vessels (‘vascular hitch’) in pure extrinsic pelvi-ureteric junction (PUJ) obstruction in children.”, BJU Int. 2011 Oct;108(8):1364-1368.

2. Gundeti MS, Reynolds WS, Duffy PG, Mushtaq I. “Further experience with the vascular hitch (laparoscopic transposition of lower pole crossing vessels): an alternate treatment for pediatric ureterovascular ureteropelvic junction obstruction.”, J Urol. 2008 Oct;180:1832-1836.

3. Schneider A, Ferreira CG, Delay C, Lacreuse I, Moog R, Becmeur F., “Lower pole vessels in children with pelviureteric junction obstruction: laparoscopic vascular hitch or dismembered pyeloplasty?”, J Pediatric Urol. 2013 Aug;9(4):419-423.


Robotic Pelvic Lymph Node Dissection

Contributors: Kristina Butler, MD and Javier Magrina, MD

Pelvic lymphadenectomy is part of most gynecologic malignancy staging procedures. Knowledge of the retroperitoneal anatomy is key to safely completing this procedure.


Editor Recruited By: Dennis S. Chi, MD, FACOG, FACS

Robotic Retroperitoneoscopic Partial Nephrectomy: 4-Arm Technique

In this video, we demonstrate the set-up, port configuration, and key steps involved in performing a robotic-assisted retroperitoneoscopic partial nephrectomy.


Open Anterograde Anatomic Radical Retropubic Prostatectomy Technique R2PA2

This video describes step by step a new surgical technique for performing “Open Anterograde Anatomic Radical Retropubic Prostatectomy” (R2PA2) for the treatment of prostate cancer in the same way as performed by the robot, without the need for using the robotic platform, video or any equipment other than those used in the conventional open surgery described by Patrick Walsh in 1983. This prospective and randomized study is registered in the identifier number: NCT02687308, and the full description of this technique was published in: Fabricio et al., Surgery Curr Res 2017, 7:5
DOI: 10.4172/2161-1076.1000304.

Authors: Borges Carrerette F. 1, Damião R. 1, Barberan J.P. 1, Mendes Miranda T. 1, Almeida Gazzoli R. 1, Lucio Carrasco C.H. 1, Alves Machado H. 1, Figueiredo Filho R.T. 1, Da Silva E.A.. 1, Costa Lara C. 1, Freire F. 1,

1 Pedro Ernesto University Hospital, Rio de Janeiro State University, Surgery, Urology, Rio de Janeiro, Brazil.

Partial Penectomy due to Penile Calciphylaxis

Partial penectomy is the surgical standard of care for invasive tumors of the mid to distal penis, but is utilized in cases of distal penile calciphylaxis due to pain. Partial Penectomy is advantageous compared to a total penectomy, as the patient is able to urinate in the standing position.

A 51-year-old man on dialysis for end stage renal disease presented to the emergency department with pain that was increasing in severity for over a month at the glans of the penis.  On examination, the glans of the penis was firm with gangrenous necrosis extending distal to the corona, and the urethral meatus was not identified due to the extensive scarring.  A clinical diagnosis of penile calciphylaxis was determined and a Partial Penectomy was subsequently performed.  Calciphylaxis is a rare life-threatening systemic disease in patients with end stage renal disease due to medial calcification and fibrosis of blood vessels leading to infection and gangrene.  The prognosis for penile calciphylaxis tends to be poor with an overall mortality of 64% with a mean time to death of 2.5 months.

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