Laparoscopic Ureteral Reanastomosis Using Fibrin Glue

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Abstract
Using 10 female pigs, an open ureteral resection and suture anastomosis (5 pigs) was compared to a laparoscopic resection and a fibrin glue anastomosis (5 pigs). The fibrin glue technique was performed by laparoscopically excising a ureteral segment, placing 2 transmural sutures over a stent and sealing the anastomosis with tissue adhesive, a mixture of concentrated fibrinogen and thrombin. At 4 weeks the stent was removed. At 8 weeks, the animals underwent antegrade pyelograms and Whittaker renal pelvis perfusion test and then were sacrificed. The experimental group had 1 anastomotic breakdown; all others had patent ureters. Radiographically, both groups demonstrated mild to moderate hydroureteronephrosis. Renal pelvis perfusion tests were higher in the fibrin glue group (12.6 cm. H2O versus 3.0 cm. H2O); however, all were normal for the porcine model. Histologic evaluation demonstrated increased muscular and serosal fibrosis and inflammation in the fibrin glue group when compared with the control group. Laparoscopic ureteral reanastomosis with fibrin glue is feasible; however, further research is needed to understand its full potential in urology.