Comparison Between Classic Laparoscopic Dismembered Pyeloplasty and Insitu Spatulation with Pre-Dismembering Ureteropelvic Angle Suturing.

"After proper dissection of the PUJ, the anterior wall of the renal pelvis was incised.~The incision continued downwards and laterally towards the PUJ and the lateral aspect of the ureter.~In cases where crossing vessels were present, the pelvis with the PUJ and the uppermost part of the ureter were properly dissected from these vessels. This gave a wide room for pulling the pelvis upwards and gentle retraction of the crossing vessels allowing incision of the anterior wall of the pelvis and starting the spatulation of the PUJ. Spatulation could then continue to the upper ureter behind the properly dissected and retracted vessels.~After complete spatulation and before dismembering the PUJ, we made benefit of splinting the ureter in place; a Maryland grasper opened the lumen of the ureter and the first stitch was precisely placed from outside inwards at the proper angle of the ureteric spatulation using 5/0 Vicryl sutures.~The posterior wall of the PUJ and the pelvis was then dismembered"

the PUJ was dismembered after proper dissection, the lateral aspect of the ureter was spatulated and the first stich was also placed in the spatulation angle from outside inwards. All these steps were done after the discontinuation of the ureter and the pelvis, losing the benefit of ureteric splinting and orientation