[Principles of urinary tract reconstructive surgery.]

Juan Gomez Rivas, Jesús Cisneros Ledo

In the last 15 years, the role of laparoscopic surgery has progressively increased to include reconstructive procedures such as pyeloplasty and management of ureteral stricture, in addition to being a field in continuous development, this refers to the improvement of ergonomics, new instruments and new techniques. We present a review on basic features of laparoscopic reconstructive surgery in urology. For this review, an exhaustive literature search was performed in PUBMED, MEDILNE, BioMed central and others, with the keywords: reconstructive surgery, urology, laparoscopy. Only articles including urologic procedures in the adult and published in the last 6 years, were selected for this review. One of the objectives of any urological reconstructive procedure is to treat any segment of the genitourinary tract that is obstructed due to scar tissue following trauma or iatrogenic causes. After the excision of such segment or scar, a mobilization of the 2 healthy extremities of the urinary tract must be performed in order to proceed with a tension-free anastomosis. Occasionally, if there is tension, a mobilization of the organs at each side of the lesion should be performed to reduce the tension of the anastomosis; also, it should be a water-tight anastomosis to ensure good functional results. Another type of procedure is to perform laparoscopic repair surgery of pelvic organ prolapse in which the vaginal anatomy should be adequately restored, with good function maintained (sexual, urinary, intestinal) and durability. With the worldwide expansion of minimally invasive surgery in the area of laparoscopy and robotics, it has been possible to reproduce many of the reconstructive techniques that have followed the evolutionary course of surgery from the open to the robot assisted technique, which has made clear that such therapeutic options exist and are reproducible with good results.