Korean J Urol.  2010 Jun;51(6):403-408.

Transumbilical Laparoendoscopic Single-Site Ureterolithotomy for Large Impacted Ureteral Stones: Initial Experiences

• Kim TH
• Jeong BC
• Seo SI
• Jeon SS
• Han DH

Abstract

PURPOSE
We presented our initial clinical experiences with transumbilical laparoendoscopic single-site (LESS) ureterolithotomy for large, impacted ureteral stones.
MATERIALS AND METHODS
Between March 2009 and November 2009, seven LESS ureterolithotomies were performed at our institute. During the operation, we made a single 2 cm incision at the umbilicus and a homemade port by using a small wound retractor (Alexis(R), Applied Medical, Rancho Santa Margarita, USA), a surgical glove, and conventional trocars. The operation was performed in the same manner as conventional laparoscopic surgery. The mean maximal stone diameter was 21.9 mm (range, 16.0-27.0 mm). There were six cases of upper ureteral stones and one case of a mid-ureteral stone. Perioperative and postoperative parameters were evaluated.
RESULTS
The mean operative time was 197.1 min (range, 150-270 min). No transfusions were required. The mean postoperative hospital stay was 3.3 days (range, 2-6 days). The mean pain intensity on a visual analogue scale (VAS) on postoperative day 2 was 26 mm (range, 0-80 mm), and the mean cosmetic VAS at 6 weeks after the operation was 0 mm. The mean time for patients to return to their baseline activities was 4.0 days (range, 3-7 days). In six cases, all stones were completely removed on the basis of postoperative radiologic evaluation. There were no cases of major complications, including internal organ injury, urinary leakage, or urinary tract infection.
CONCLUSIONS
Transumbilical LESS ureterolithotomy can be considered as an alternative treatment option with minimal invasiveness and good effectiveness for large, impacted ureteral stones.

Keyword

Instrumentation; Laparoscopy; Minimally invasive surgical procedures; Ureterolithiasis

MeSH Terms

Cosmetics
Gloves, Surgical
Humans
Laparoscopy
Length of Stay
Operative Time
Surgical Instruments
Surgical Procedures, Minimally Invasive
Umbilicus
Ureter
Ureterolithiasis
Urinary Tract Infections
Cosmetics

Figure

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  FIG. 1 Impacted ureteral stones (A, B). Hydroureteronephrosis above the calculus and a nonvisualized ureter below it are seen on IVU (C). A guidewire cannot be passed by the stone. Black arrow: impacted ureteral stone.

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  FIG. 2 Homemade multichannel port using a small wound retractor (Alexis®, Applied Medical, Rancho Santa Margarita, USA), a surgical glove, and conventional trocars (12 mm, 12 mm, 5 mm).

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  FIG. 3 Ureteral stone removal using straight or articulating grasping forceps via an ureteral incision site.

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  FIG. 4 Six-week postoperative external image of an umbilical wound in a patient who underwent LESS ureterolithotomy.

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