Laparoscopic Ureterolithotomy for Upper Ureter Stone with Some Modified Surgical Tips

Abstract

Introduction and Objective: To report large upper ureter stone removal by laparoscopic approach with some surgical tips using Carter–Thomason fascial closure and various modified instruments. Methods: A 45-year-old man underwent laparoscopic ureterolithotomy via transperitoneal approach. In semilateral position, skin and fascial incision (1.2 cm) was made lateral to rectus muscle at umbilicus level, and 10-mm balloon trocar was used for scope. Two 5-mm trocars for working channel were inserted consecutively. After periureter tissue dissection, ureter with stone was pulled with nylon tape and black silk. Carter–Thomason fascial closure was used to extract the black silk outside of body and the proper traction tension and level; the angle was adjusted by the black silk extracorporeally to make next procedure more easily. Then, the ureter incision was made by modified instrument: needle holder with broken 15th blade tip, so we can sharply and precisely incise ureter at stone level. Next, the stone was removed, and a modified, both-end-closed ureteral catheter was inserted by bidirectional way using two guide wires. The ureter traction tension and level were readjusted to insert the ureteral catheter more easily. Ureteral incision was closed with an absorbable suture material (vicryl 4-0) by interrupt method, and drain was indwelled. Results: We can finish the whole procedure with a 1.2-mm balloon trocar and two 5-mm working trocars. The removed stone was 1.6 cm. The operative time was 136 minutes and blood loss was minimal. There was no intraoperative or postoperative complication. The patient was discharged 3 days after the operation. Conclusions: Pulling ureter using Carter–Thomason fascial closure and black silk makes ureter handling easier. Needle holder with broken 15th blade tip and a modified, both-end-closed ureteral catheter by bidirectional way using two guide wires make laparoscopic ureterolithotomy more feasible, so we can sharply and precisely incise ureter and insert the ureteral catheter more easily. In our experience, these tiny surgical tips are useful and can be applied to laparoscopic ureterolithotomy. No competing financial interests exist. Runtime of video: 6 mins 3 secs