Transvaginal Ureteral Reimplantation
This page retains an operative-video resource for an emerging approach. The linked publications below establish transabdominal single-port ureteral reimplantation and cadaver feasibility of transvaginal nephrectomy. They do not, individually or together, establish clinical outcomes for transvaginal retroperitoneal ureteral reimplantation.[1][2][3]
For established operative principles and patient selection, see Ureteral Reimplantation. For access technology, see vNOTES & Robotic vNOTES.
What the Published Sources Show
| Source | Actual procedure and evidence |
|---|---|
| Kaouk 2019 | Three transabdominal SP reconstructive cases. These support platform feasibility, not a transvaginal approach.[1] |
| Hebert 2019 | A single ureteroneocystostomy through a 25-mm infraumbilical incision, with percutaneous stent placement. It was not transvaginal surgery.[2] |
| Laydner 2013 | Robotic transvaginal nephrectomy in three cadavers. One retroperitoneal procedure succeeded; another sustained rectal injury during access and could not be completed. This does not validate ureteral reimplantation or prove clinical safety.[3] |
Evidence and Safety Limits
A posterior colpotomy does not by itself establish an entirely retroperitoneal route or absence of peritoneal entry. Access anatomy, rectal and bladder protection, vascular reach, tension-free reimplantation, stenting, and secure vaginal closure must be demonstrated for the exact technique. Outcomes from transabdominal repairs should not be assigned to a transvaginal variant.
The potential avoidance of abdominal incisions does not establish less pain, fewer adhesions, equivalent patency, or better sexual outcomes. Procedure-specific reports should document access complications, conversion, infection or fistula, vaginal healing, patient-reported outcomes, renal drainage, and durable freedom from reintervention before those advantages are claimed.
See Also
- vNOTES & Robotic vNOTES
- Single-Port Robotics
- Ureteral Reimplantation
- Boari Flap with Psoas Hitch
- Upper Tract Reconstruction Principles
Videos
References
1. Kaouk JH, Garisto J, Eltemamy M, Bertolo R. Robot-assisted surgery for benign distal ureteral strictures: step-by-step technique using the SP surgical system. BJU Int. 2019;123(4):733–739. doi:10.1111/bju.14635
2. Hebert KJ, Joseph J, Gettman M, et al. Technical considerations of single-port ureteroneocystostomy utilizing the da Vinci SP platform. Urology. 2019;129:236. doi:10.1016/j.urology.2019.03.020
3. Laydner H, Autorino R, Isac W, et al. Robotic retroperitoneal transvaginal natural orifice translumenal endoscopic surgery (NOTES) nephrectomy: feasibility study in a cadaver model. Urology. 2013;81(6):1232–1237. doi:10.1016/j.urology.2012.11.083