CU 06. Difficulties of retroperitoneal laparoscopic ureterolithotomy for upper ureteral calculi in learning curve in 33 patients

Objective: To investigate the difficulties of retroperitoneal laparoscopic ureterolithotomy (RLU) for upper ureteral calculi in learning curve.

Methods: The clinical data of 33 patients (25 males and 8 females) who were treated between July 2007 and December 2010 were retrospectively analyzed. These patients underwent consecutive retroperitoneal laparoscopic ureterolithotomy during the learning curve period in laparoscopy. Patients were divided into group A and group B based on environment order. Timing for ureter isolation, ureteral double J stent placement, and ureter suturing were recorded. The intra-operative complications and peri-operative morbidities were also reported.

Results: The stone size was not significantly different between these two groups (22±5.5 vs. 20±5.0 mm, P>0.05). Significant differences between group A and B were observed in terms of time for access to the operating field (mean: 24 vs. 10 min, P<0.05), time for double J ureteric stent placement (mean: 18 vs. 8 min, P<0.05) time for suturing the ureter (mean: 30 vs. 13 min, P<0.05), and total operative time (mean: 116 vs. 72 min, P<0.05). No statistical differences were observed for any other parameters. Blood loss was minimal in all cases (mean loss: 67 mL vs. 50 mL, P>0.05). One patient developed urinary leakage because of displacement double J ureteric stent. During the 6-month followup, one case of ureteral stricture was recorded in group A.

Conclusions: The operative difficulties include ureter isolation, ureteral double J stent placement, and ureter suturing during the learning curve period duing RLU.