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Int. J. Life. Sci. Scienti. Res., 2(6): 737-741 NOVEMBER- 2016
http://ijlssr.com Copyright © 2015-2016 International Journal of Life-Sciences Scientific Research Page 737
Evaluation of Laparoscopic Retroperitoneal
Ureterolithotomy for Large Upper and Middle
Ureteric Calculi at a Tertiary Health Care Level
Dr Pawan Sharma1
*, Dr D K Verma2
, Dr Raj Kumar3
1
General Surgeon Incharge, Civil Hospital Rohru, Shimla (HP), India
2
Professor of Surgery, IGMC Shimla (HP), India
3
General Surgeon Incharge, Distt Hospital Bilaspur (HP), India
*
Address for Correspondence: Dr. Pawan Sharma, General Surgeon Incharge, Department of Surgery, Civil Hospital,
Rohru, Shimla, HP, India
Received: 17 September 2016/Revised: 11 October 2016/Accepted: 25 October 2016
ABSTRACT- This study was carried out to evaluate laparoscopic retroperitoneal ureterolithotomy (RPUL) as a viable
option to open surgical ureterolithotomy, laparoscopic transperitoneal ureterolithotomy (TPUL) & endoscopic urology and
to assess its place in the spectrum of alternatives for the surgical treatment of ureteric calculi in a tertiary care centre. This
study was conducted on 20 selected patients of single large impacted calculus of size more than 8mm in upper & middle
ureter. It was observed that excessive bleeding was present in only one (5%) of the patients, while need for conversion to
open ureterolithotomy was seen in 8 (40%) cases. No major peri-operative complications were encountered. From our
experience, it can be concluded that this procedure has definitely shown decreased post-operative discomfort, decreased
requirement of post-operative analgesia, better cosmesis, early return to work and less morbidity. RPUL can be considered
as another well-established armamentarium in the armour of laparoscopic surgeons and is recommended as an effective
minimally invasive primary treatment in large, impacted difficult stones in the upper & mid ureter.
Key-words- Retroperitoneal ureterolithotomy (RPUL), Transperitoneal ureterolithotomy (TPUL), Extracorporeal
shockwave lithotripsy (ESWL)
-------------------------------------------------IJLSSR-----------------------------------------------
INTRODUCTION
Urinary tracts stone disease, which is one of the most
common afflictions of modern society, has been described
since antiquity. With westernization of global culture the
site of stone formation has migrated from the lower to the
upper urinary tract and the disease once limited to men has
increasingly become gender blind. Until the 1980s, most
ureteric calculi that required treatment were managed by
open surgical ureterolithotomy or endoscopic basket
extraction. Revolutionary advances in the minimally
invasive and non invasive management of stone disease
over the past 3 decades have greatly facilitated the ease
with which stones are removed.
Access this article online
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Website:
www.ijlssr.com
DOI: 10.21276/ijlssr.2016.2.6.14
The advent of extracorporeal shockwave lithotripsy
(ESWL), per cutaneous renal surgery and ureteroscopy
with endoscopic lithotripsy has almost eliminated the need
for open surgical ureterolithotomy. There remains,
however, a group of hard core calculi that are poorly
treated by minimally invasive means, being stones that are
large, hard, long-standing, impacted and in particular those
situated in upper or middle ureter. In such cases surgical
ureterolithotomy still is necessary, with its concomitant
invasive trauma, major incision, postoperative pain,
significant hospital stay and protracted convalescence.
During the last decade laparoscopic surgery has added a
further endoscopic minimally invasive option in urology.
Since the description of laparoscopic lymphadenectomy [1]
and laparoscopic nephrectomy [2]
the role of laparoscopy in
urology has expanded enormously. A number of different
ureteric procedures have been performed including
nephro-ureterectomy [3]
, ureterolysis [4]
, ureteric resection
and repair [5]
.
This study was carried out to evaluate laparoscopic
retroperitoneal ureterolithotomy as a viable option to open
surgical ureterolithotomy, laparoscopic transperitoneal
ureterolithotomy & endoscopic urology and to assess its
Research Article (Open access)
Int. J. Life. Sci. Scienti. Res., VOL 2, ISSUE 6
http://ijlssr.com Copyright © 2015-2016 International Journal of Life-Sciences Scientific Research Page 738
place in the spectrum of alternatives for the surgical
treatment of ureteric calculi in a tertiary care centre.
MATERIALS AND METHODS
This study was conducted for duration of one year on
twenty selected patients of large upper and middle ureteric
calculi in the department of General Surgery, Indira Gandhi
Medical College, Shimla, India. The objective of this study
was to evaluate the efficacy and safety of laparoscopic
retroperitoneal ureterolithotomy for management of large
upper and middle ureteric calculi on the following
parameters. Duration of surgery,CO2 used, Conversion rate
to open, Intra-operative complication, Postoperative
complication, Hospital stay, Analgesic requirement & Our
status as compared to literature.
Operative Technique
All patients were given general anesthesia. A 2cm muscle
splitting incision was made just below the tip of 12th rib.
The transversalis fascia was incised and the possible para
renal space was developed bluntly with a finger. We used a
No.7 glove fixed to the end of a No.8 Nelaton catheter as a
Balloon dilator. The dilator was placed into the
retroperitoneal space under digital control and was inflated
with normal saline. After balloon deflation and removal,
a10mm Hassan trocar was inserted and a
pneumo-retroperitoneum was created withCO2 insufflation.
One 10mm trocar was inserted on anterior axillary line 3cm
cephalic to anterior superior iliac spine and one 5mm trocar
was inserted at the junction of paraspinalis and 12th rib.
Three ports were placed on transverse line in preparation
for open conversion in case the laparoscopic approach
failed. After identifying the ureter on the psoas muscle, the
bulge of the stone was located and ureter incised directly
over the bulge longitudinally with the cold knife. The stone
was removed using a grasping forceps and ureterotomy was
closed with 4-0 vicryl using an intra-corporeal suture.
Double J stent was placed laparoscopically. Drain was kept
through one of the 10mm ports. The drain was removed
after the drain output decreased to below 30cc.
RESULTS
The mean age of the patients was 38.30 years. On an
average 44.51 litres of gas (CO2) per case was used in this
series. No such reports are available regarding the
consumption of gas in literature. Mean operating time was
76.60 minutes (Fig 1).
Fig 1: Mean time (minutes) for each case
Operative Complications
None of our patients had any per-operative complications like pneumo-omentum, subcutaneous emphysema,
pneumothorax, bleeding from abdominal wall, GIT perforation, solid visceral injury, major vascular injury, or ureteric
avulsion which have been otherwise reported in literature. No postoperative complications like port site infection, abscess
or deep vein thrombosis were seen in any patients (Fig 2).
Int. J. Life. Sci. Scienti. Res., VOL 2, ISSUE 6
http://ijlssr.com Copyright © 2015-2016 International Journal of Life-Sciences Scientific Research Page 739
Fig 2: Post operative complications
Stone Size
All cases under study were having a single stone in upper or middle ureter. The smallest stone was 0.9cm and the largest
stone was 1.8 cms in size (Fig 3).
Fig 3: Stone size and average size (cms.)
DISCUSSION
Pain, Number of Attack and Adhesions
In the present study 100% (20) of patients complained of
pain prior to admission. Our evaluation show that presence
of adhesions in the patients were related to number of
attacks of pain and patients having no adhesions suffered
less attacks of pain. Patients with adhesions suffered
average 3.83 attacks of pain as compared to patients
without adhesion who suffered on an average 3.42 painful
attacks. The relation between number of attacks of pain and
adhesions was statistically significant (P value 0.4210).
Time Taken for Surgery
The mean time taken for completion of the procedure in our
Int. J. Life. Sci. Scienti. Res., VOL 2, ISSUE 6
http://ijlssr.com Copyright © 2015-2016 International Journal of Life-Sciences Scientific Research Page 740
series was 76.60 minutes (range 35 to 125 min.). Kwon [6]
observed mean operating time of 109 minutes (range 90 to
120 minutes). Tejanshu [7]
observed mean operating time of
82 minutes (range 60 to 120 minutes). Gaur [8]
had mean
operating time of 79 minutes and Goel [9]
reported a mean
operating time of 108.8 minutes (range 40 to 275 minutes).
However, variation in time taken for surgery in the present
cases can be ascribed to the various factors like initial
teething troubles, maiden technique, and non-availability of
trained regular supporting staff familiar with the technique.
Gas (CO2) Consumed
On an average 44.51 litres of gas (CO2) per case was used
in this series, ranging from 14 to 80 liters. No such reports
are available regarding the consumption of gas in literature
[10]
.
Conversion
In the present series 8(40%) of our cases were converted
into open ureterolithotomy. However, there is wide
variation in open conversion rate in literature. Jeong [11]
observed open conversion rate of 50%. The reason for open
conversion in our study was periureteric adhesions,
peri-ureteritis and intra-operative bleeding.
Intra-Operative Complications
Adhesions
Only six of our patients (30%) had multiple peri-ureteric
adhesions. Adhesions presented difficulty in dissection
during the procedure. All (30%) of them were converted to
open surgery. Literature is silent regarding the causes of
presence of adhesion.
Spillage of Stone
None of our patients under study had spillage of stone
during procedure.
Bleeding
We encountered minor bleeding during procedure in few
cases. We encountered major bleeding in one (5%) of our
cases. The case was completed by converting to open
surgery. It was not a bleeding from any major vessel but
probably from increased vascularity due to periureteritis.
Major Vessel and Visceral Injuries
None of our patients sustained these injuries as depicted in
literature.
Genito Urinary Injuries
None of our cases encountered bladder or ureteric injuries
(avulsion) as reported in the literature.
Post-Operative Complications
In the present series none of the patients had wound (port
/incision site) infection, abscess formation, prolonged ileus
or deep vein thrombosis as reported in literature.
Hospital Stay
There is wide variation in hospital stay as observed in
literature. In our series mean hospital stay was 6.65 days.
Post-Operative Pain
The mean days of analgesic (Diclofenac) requirement for
laparoscopic RPUL were 2.55 days. There is no clear data
regarding post operative analgesic requirement in
laparoscopic RPUL in lierature.
Post-Operative IVP
All cases in the present series underwent post-operative
IVP after a period of six weeks. Only one patient developed
postoperative stricture and was managed by open
pyeloplasty with DJ stenting. Gaur & Goel all have reported
postoperative stricture in their individual case series.
DJ Stenting & Its Removal
DJ Stenting was done in one case of the present series
laparoscopically.
CONCLUSION
The increased skills of the surgeons & advances in
endoscopic equipment have made laparoscopy the
technique of future. In our experience of Laparoscopic
RPUL in Indra Gandhi Medical College, Shimla the
procedure can be done without any major complication.
The minor complications experienced in the study were
within the range as reported with the literature. One should
have good knowledge of the open ureterolithotomy and if
any complication is encountered during RPUL it should be
resorted to, as timely conversion of laparoscopy is not a
source of shame but sign of wisdom. Time taken for
surgery should be no criteria for academic groups. The
procedure has definitely shown decreased post-operative
discomfort, decreased requirement of post-operative
analgesia, better cosmesis, early return to work and less
morbidity. RPUL can be considered as another
well-established armamentarium in the armour of
laparoscopic surgeons and is recommended as an effective
minimally invasive primary treatment in large, impacted
difficult stones in the upper & mid ureter otherwise
indicated for open ureterolithotomy.
REFERENCES
[1] Schuessler WW, Vancaille TG, Reich H, Griffith DP.
Transperitoneal endosurgical lymphadenectomy in patients
with localized prostate cancer. J Urol 1991; 145:988-91.
[2] Clayman RV, Kavoussi LR, Soper NJ et al. Laparoscopic
nepherectomy. N Eng J Med 1991; 324:1370-1.
[3] Clayman RV, Kavoussi LR, Figenshau RS, Chandhoke PS,
Albala DM. Laparoscopic nephroureterectomy: initial
clinical case report. J Laparoendosc Surg 1991;1:343.
[4] Kavoussi LR, Clayman RV, Brunt M, Soper NJ.
Laparoscopic ureterolysis. J Urol 1992; 147:426-9.
[5] Nazet C, Nazhat F, Green B. Laparoscopic treatment of
obstructed ureter due to endometriosis by resection and
ureteroureterostomy: a case report. J Urol 1992; 148: 865-8.
Int. J. Life. Sci. Scienti. Res., VOL 2, ISSUE 6
http://ijlssr.com Copyright © 2015-2016 International Journal of Life-Sciences Scientific Research Page 741
[6] Kwon YU, Lee SI, Jeong TY. Treatment of upper and mid
ureter stones: Comparison of semirigid ureteroscopic
lithotripsy with holmium: YAG laser and shock wave
lithotripsy. Korean J Urol 2007;48:171–175
[7] Shah TP, Vishana K, Ranka P, Patel M, Chaudhary R:
Retroperitoneal laparoscopic ureterolithotomy-our
experience. Indian J Urol 2004;20:101-5.
[8] Gaur DD, et al. Laparoscopic ureterolithotomy: Technical
considerations and long-term follow-up. BJU Int
2002;89:339-43.
[9] Goel A, Hemal AK. Upper and mid-ureteric stones. A
prospective unrandomized comparison of
retroperitoneoscopic and open ureterolithotomy. BJU Int
2001; 88:679-82.
[10]World Journal of Laparoscopic Surgery,
September-December 2009;2(3):47-51, Mark C Cellona St.
Luke’s Medical Center, Quezon City, Philippines
[11]Jeong BC, Park HK, Byeon SS, Kim HH. Retroperitoneal
laparoscopic ureterolithotomy for upper ureter stones. J
Korean Med Sci. 2006 Jun;21(3):441-4.
International Journal of Life-Sciences Scientific Research (IJLSSR)
Open Access Policy
Authors/Contributors are responsible for originality, contents, correct
references, and ethical issues.
IJLSSR publishes all articles under Creative Commons
Attribution- Non-Commercial 4.0 International License (CC BY-NC).
https://creativecommons.org/licenses/by-nc/4.0/legalcode
How to cite this article:
Sharma P, Verma DK, Kumar R: Evaluation of Laparoscopic Retroperitoneal Ureterolithotomy for Large Upper and Middle
Ureteric Calculi at a Tertiary Health Care Level. Int. J. Life. Sci. Scienti. Res., 2016; 2(6): 737-741. DOI:10.21276/ijlssr.2016.2.6.14
Source of Financial Support: Nil, Conflict of interest: Nil

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Evaluation of Laparoscopic Retroperitoneal Ureterolithotomy for Large Upper and Middle Ureteric Calculi at a Tertiary Health Care Level

  • 1. Int. J. Life. Sci. Scienti. Res., 2(6): 737-741 NOVEMBER- 2016 http://ijlssr.com Copyright © 2015-2016 International Journal of Life-Sciences Scientific Research Page 737 Evaluation of Laparoscopic Retroperitoneal Ureterolithotomy for Large Upper and Middle Ureteric Calculi at a Tertiary Health Care Level Dr Pawan Sharma1 *, Dr D K Verma2 , Dr Raj Kumar3 1 General Surgeon Incharge, Civil Hospital Rohru, Shimla (HP), India 2 Professor of Surgery, IGMC Shimla (HP), India 3 General Surgeon Incharge, Distt Hospital Bilaspur (HP), India * Address for Correspondence: Dr. Pawan Sharma, General Surgeon Incharge, Department of Surgery, Civil Hospital, Rohru, Shimla, HP, India Received: 17 September 2016/Revised: 11 October 2016/Accepted: 25 October 2016 ABSTRACT- This study was carried out to evaluate laparoscopic retroperitoneal ureterolithotomy (RPUL) as a viable option to open surgical ureterolithotomy, laparoscopic transperitoneal ureterolithotomy (TPUL) & endoscopic urology and to assess its place in the spectrum of alternatives for the surgical treatment of ureteric calculi in a tertiary care centre. This study was conducted on 20 selected patients of single large impacted calculus of size more than 8mm in upper & middle ureter. It was observed that excessive bleeding was present in only one (5%) of the patients, while need for conversion to open ureterolithotomy was seen in 8 (40%) cases. No major peri-operative complications were encountered. From our experience, it can be concluded that this procedure has definitely shown decreased post-operative discomfort, decreased requirement of post-operative analgesia, better cosmesis, early return to work and less morbidity. RPUL can be considered as another well-established armamentarium in the armour of laparoscopic surgeons and is recommended as an effective minimally invasive primary treatment in large, impacted difficult stones in the upper & mid ureter. Key-words- Retroperitoneal ureterolithotomy (RPUL), Transperitoneal ureterolithotomy (TPUL), Extracorporeal shockwave lithotripsy (ESWL) -------------------------------------------------IJLSSR----------------------------------------------- INTRODUCTION Urinary tracts stone disease, which is one of the most common afflictions of modern society, has been described since antiquity. With westernization of global culture the site of stone formation has migrated from the lower to the upper urinary tract and the disease once limited to men has increasingly become gender blind. Until the 1980s, most ureteric calculi that required treatment were managed by open surgical ureterolithotomy or endoscopic basket extraction. Revolutionary advances in the minimally invasive and non invasive management of stone disease over the past 3 decades have greatly facilitated the ease with which stones are removed. Access this article online Quick Response Code: Website: www.ijlssr.com DOI: 10.21276/ijlssr.2016.2.6.14 The advent of extracorporeal shockwave lithotripsy (ESWL), per cutaneous renal surgery and ureteroscopy with endoscopic lithotripsy has almost eliminated the need for open surgical ureterolithotomy. There remains, however, a group of hard core calculi that are poorly treated by minimally invasive means, being stones that are large, hard, long-standing, impacted and in particular those situated in upper or middle ureter. In such cases surgical ureterolithotomy still is necessary, with its concomitant invasive trauma, major incision, postoperative pain, significant hospital stay and protracted convalescence. During the last decade laparoscopic surgery has added a further endoscopic minimally invasive option in urology. Since the description of laparoscopic lymphadenectomy [1] and laparoscopic nephrectomy [2] the role of laparoscopy in urology has expanded enormously. A number of different ureteric procedures have been performed including nephro-ureterectomy [3] , ureterolysis [4] , ureteric resection and repair [5] . This study was carried out to evaluate laparoscopic retroperitoneal ureterolithotomy as a viable option to open surgical ureterolithotomy, laparoscopic transperitoneal ureterolithotomy & endoscopic urology and to assess its Research Article (Open access)
  • 2. Int. J. Life. Sci. Scienti. Res., VOL 2, ISSUE 6 http://ijlssr.com Copyright © 2015-2016 International Journal of Life-Sciences Scientific Research Page 738 place in the spectrum of alternatives for the surgical treatment of ureteric calculi in a tertiary care centre. MATERIALS AND METHODS This study was conducted for duration of one year on twenty selected patients of large upper and middle ureteric calculi in the department of General Surgery, Indira Gandhi Medical College, Shimla, India. The objective of this study was to evaluate the efficacy and safety of laparoscopic retroperitoneal ureterolithotomy for management of large upper and middle ureteric calculi on the following parameters. Duration of surgery,CO2 used, Conversion rate to open, Intra-operative complication, Postoperative complication, Hospital stay, Analgesic requirement & Our status as compared to literature. Operative Technique All patients were given general anesthesia. A 2cm muscle splitting incision was made just below the tip of 12th rib. The transversalis fascia was incised and the possible para renal space was developed bluntly with a finger. We used a No.7 glove fixed to the end of a No.8 Nelaton catheter as a Balloon dilator. The dilator was placed into the retroperitoneal space under digital control and was inflated with normal saline. After balloon deflation and removal, a10mm Hassan trocar was inserted and a pneumo-retroperitoneum was created withCO2 insufflation. One 10mm trocar was inserted on anterior axillary line 3cm cephalic to anterior superior iliac spine and one 5mm trocar was inserted at the junction of paraspinalis and 12th rib. Three ports were placed on transverse line in preparation for open conversion in case the laparoscopic approach failed. After identifying the ureter on the psoas muscle, the bulge of the stone was located and ureter incised directly over the bulge longitudinally with the cold knife. The stone was removed using a grasping forceps and ureterotomy was closed with 4-0 vicryl using an intra-corporeal suture. Double J stent was placed laparoscopically. Drain was kept through one of the 10mm ports. The drain was removed after the drain output decreased to below 30cc. RESULTS The mean age of the patients was 38.30 years. On an average 44.51 litres of gas (CO2) per case was used in this series. No such reports are available regarding the consumption of gas in literature. Mean operating time was 76.60 minutes (Fig 1). Fig 1: Mean time (minutes) for each case Operative Complications None of our patients had any per-operative complications like pneumo-omentum, subcutaneous emphysema, pneumothorax, bleeding from abdominal wall, GIT perforation, solid visceral injury, major vascular injury, or ureteric avulsion which have been otherwise reported in literature. No postoperative complications like port site infection, abscess or deep vein thrombosis were seen in any patients (Fig 2).
  • 3. Int. J. Life. Sci. Scienti. Res., VOL 2, ISSUE 6 http://ijlssr.com Copyright © 2015-2016 International Journal of Life-Sciences Scientific Research Page 739 Fig 2: Post operative complications Stone Size All cases under study were having a single stone in upper or middle ureter. The smallest stone was 0.9cm and the largest stone was 1.8 cms in size (Fig 3). Fig 3: Stone size and average size (cms.) DISCUSSION Pain, Number of Attack and Adhesions In the present study 100% (20) of patients complained of pain prior to admission. Our evaluation show that presence of adhesions in the patients were related to number of attacks of pain and patients having no adhesions suffered less attacks of pain. Patients with adhesions suffered average 3.83 attacks of pain as compared to patients without adhesion who suffered on an average 3.42 painful attacks. The relation between number of attacks of pain and adhesions was statistically significant (P value 0.4210). Time Taken for Surgery The mean time taken for completion of the procedure in our
  • 4. Int. J. Life. Sci. Scienti. Res., VOL 2, ISSUE 6 http://ijlssr.com Copyright © 2015-2016 International Journal of Life-Sciences Scientific Research Page 740 series was 76.60 minutes (range 35 to 125 min.). Kwon [6] observed mean operating time of 109 minutes (range 90 to 120 minutes). Tejanshu [7] observed mean operating time of 82 minutes (range 60 to 120 minutes). Gaur [8] had mean operating time of 79 minutes and Goel [9] reported a mean operating time of 108.8 minutes (range 40 to 275 minutes). However, variation in time taken for surgery in the present cases can be ascribed to the various factors like initial teething troubles, maiden technique, and non-availability of trained regular supporting staff familiar with the technique. Gas (CO2) Consumed On an average 44.51 litres of gas (CO2) per case was used in this series, ranging from 14 to 80 liters. No such reports are available regarding the consumption of gas in literature [10] . Conversion In the present series 8(40%) of our cases were converted into open ureterolithotomy. However, there is wide variation in open conversion rate in literature. Jeong [11] observed open conversion rate of 50%. The reason for open conversion in our study was periureteric adhesions, peri-ureteritis and intra-operative bleeding. Intra-Operative Complications Adhesions Only six of our patients (30%) had multiple peri-ureteric adhesions. Adhesions presented difficulty in dissection during the procedure. All (30%) of them were converted to open surgery. Literature is silent regarding the causes of presence of adhesion. Spillage of Stone None of our patients under study had spillage of stone during procedure. Bleeding We encountered minor bleeding during procedure in few cases. We encountered major bleeding in one (5%) of our cases. The case was completed by converting to open surgery. It was not a bleeding from any major vessel but probably from increased vascularity due to periureteritis. Major Vessel and Visceral Injuries None of our patients sustained these injuries as depicted in literature. Genito Urinary Injuries None of our cases encountered bladder or ureteric injuries (avulsion) as reported in the literature. Post-Operative Complications In the present series none of the patients had wound (port /incision site) infection, abscess formation, prolonged ileus or deep vein thrombosis as reported in literature. Hospital Stay There is wide variation in hospital stay as observed in literature. In our series mean hospital stay was 6.65 days. Post-Operative Pain The mean days of analgesic (Diclofenac) requirement for laparoscopic RPUL were 2.55 days. There is no clear data regarding post operative analgesic requirement in laparoscopic RPUL in lierature. Post-Operative IVP All cases in the present series underwent post-operative IVP after a period of six weeks. Only one patient developed postoperative stricture and was managed by open pyeloplasty with DJ stenting. Gaur & Goel all have reported postoperative stricture in their individual case series. DJ Stenting & Its Removal DJ Stenting was done in one case of the present series laparoscopically. CONCLUSION The increased skills of the surgeons & advances in endoscopic equipment have made laparoscopy the technique of future. In our experience of Laparoscopic RPUL in Indra Gandhi Medical College, Shimla the procedure can be done without any major complication. The minor complications experienced in the study were within the range as reported with the literature. One should have good knowledge of the open ureterolithotomy and if any complication is encountered during RPUL it should be resorted to, as timely conversion of laparoscopy is not a source of shame but sign of wisdom. Time taken for surgery should be no criteria for academic groups. The procedure has definitely shown decreased post-operative discomfort, decreased requirement of post-operative analgesia, better cosmesis, early return to work and less morbidity. RPUL can be considered as another well-established armamentarium in the armour of laparoscopic surgeons and is recommended as an effective minimally invasive primary treatment in large, impacted difficult stones in the upper & mid ureter otherwise indicated for open ureterolithotomy. REFERENCES [1] Schuessler WW, Vancaille TG, Reich H, Griffith DP. Transperitoneal endosurgical lymphadenectomy in patients with localized prostate cancer. J Urol 1991; 145:988-91. [2] Clayman RV, Kavoussi LR, Soper NJ et al. Laparoscopic nepherectomy. N Eng J Med 1991; 324:1370-1. [3] Clayman RV, Kavoussi LR, Figenshau RS, Chandhoke PS, Albala DM. Laparoscopic nephroureterectomy: initial clinical case report. J Laparoendosc Surg 1991;1:343. [4] Kavoussi LR, Clayman RV, Brunt M, Soper NJ. Laparoscopic ureterolysis. J Urol 1992; 147:426-9. [5] Nazet C, Nazhat F, Green B. Laparoscopic treatment of obstructed ureter due to endometriosis by resection and ureteroureterostomy: a case report. J Urol 1992; 148: 865-8.
  • 5. Int. J. Life. Sci. Scienti. Res., VOL 2, ISSUE 6 http://ijlssr.com Copyright © 2015-2016 International Journal of Life-Sciences Scientific Research Page 741 [6] Kwon YU, Lee SI, Jeong TY. Treatment of upper and mid ureter stones: Comparison of semirigid ureteroscopic lithotripsy with holmium: YAG laser and shock wave lithotripsy. Korean J Urol 2007;48:171–175 [7] Shah TP, Vishana K, Ranka P, Patel M, Chaudhary R: Retroperitoneal laparoscopic ureterolithotomy-our experience. Indian J Urol 2004;20:101-5. [8] Gaur DD, et al. Laparoscopic ureterolithotomy: Technical considerations and long-term follow-up. BJU Int 2002;89:339-43. [9] Goel A, Hemal AK. Upper and mid-ureteric stones. A prospective unrandomized comparison of retroperitoneoscopic and open ureterolithotomy. BJU Int 2001; 88:679-82. [10]World Journal of Laparoscopic Surgery, September-December 2009;2(3):47-51, Mark C Cellona St. Luke’s Medical Center, Quezon City, Philippines [11]Jeong BC, Park HK, Byeon SS, Kim HH. Retroperitoneal laparoscopic ureterolithotomy for upper ureter stones. J Korean Med Sci. 2006 Jun;21(3):441-4. International Journal of Life-Sciences Scientific Research (IJLSSR) Open Access Policy Authors/Contributors are responsible for originality, contents, correct references, and ethical issues. IJLSSR publishes all articles under Creative Commons Attribution- Non-Commercial 4.0 International License (CC BY-NC). https://creativecommons.org/licenses/by-nc/4.0/legalcode How to cite this article: Sharma P, Verma DK, Kumar R: Evaluation of Laparoscopic Retroperitoneal Ureterolithotomy for Large Upper and Middle Ureteric Calculi at a Tertiary Health Care Level. Int. J. Life. Sci. Scienti. Res., 2016; 2(6): 737-741. DOI:10.21276/ijlssr.2016.2.6.14 Source of Financial Support: Nil, Conflict of interest: Nil