Moscow surgeons restored a little boy’s damaged ureter using his appendix for the first time in Russia. The unique laparoscopic operation helped minimise tissue damage.
The five-year-old boy was sent to the Research Institute of Emergency Paediatric Surgery after a car accident, with doctors diagnosing him with a ruptured ureter that had become detached from the pelvis of his right kidney. The boy was likely to lose his kidney after this severe injury.
Doctors had two options to save the kidney: They could put a drainage tube for removing urine, or they could try to reattach the ureter.
“When we attempted to reattach the ureter to the renal pelvis, we saw that the dome of the caecum was conveniently located near the appendix. So, we decided to use the latter to fix the problem,” said Nikita Dyomin, a urology surgeon at the Research Institute of Emergency Paediatric Surgery.
It proved impossible to reattach the ureter to the renal pelvis because of the three-centimetre rupture and because the excessive strain would have caused blood and lymph to accumulate inside tissues. Therefore, doctors placed a special tube inside the renal pelvis and started preparing the boy for reconstructive surgery.
“We had a difficult job singling out the kidney and locating the virtually non-existent renal pelvis. We reduced the ureter still further because some tissues had been bruised during the accident. The rupture had grown, reaching about five centimetres. The appendix, which is nearly the same length, helped us solve the problem,” Dyomin added.
Doctors stitched a section of the appendix to the ureter, attaching its other section to the renal pelvis. They put in a stent and kept in place the temporary urine-draining tube that will be removed in 45-60 days; all urine will be discharged via the new ureter.
Since early 2018, city surgeons have performed over 100,000 low-invasive laparoscopic operations and over 1,000 robot-assisted operations. This year, the city’s healthcare system received a robotic brain surgery system. The system made it possible to carry out the first-ever neurosurgery operation at the Sklifosovsky Research Institute of Emergency Medicine.