Laparoscopic (or) open ureterolithotomy (OU) both are been used as initial treatment of impacted, large ureteral stones which is having size of 1.5 cm. As a recovery procedure in some failed cases of ESWL and attempted URS/PNL. Laparoscopic ureterolithotomy by transperitoneal route is a adaptable and different method for ureteric stones in any locations. The benefits of laparoscopic ureterolithotomy by using transperitoneal route are big peritoneal space for handling of the instruments and intra-corporal suturing making this method relatively easy. Laparoscopic transperitoneal ureterolithotomy is minimally invasive and treatment will be more effective modality and safe procedure and performed by all skilled surgeons. Difficulty may cause in some situations like: if patient’s are previously operated, obese patients and lower ureteral stones can be overcome by experience.
PROCEDURE OF LAPAROSCOPIC URETEROLITHOTOMY:
The surgery was done by 3 ports, a 10 mm camera trocar introduced or inserted, 2 finger breadth lateral and superior to the umbilicus, and additional 2, 5 mm working ports were inserted a handbreadth inferior and superior to the camera port.
A fourth 5 mm trocar is rarely used for liver retraction in right-sided cases. After reflection of colon, the ureter was recognized and where the stone was located and extract by a vertical ureterotomy.
Then a 6F DJ stent was inserted and the ureterotomy is blocked with 4/0 vicryl sutures. By using a 5 mm scope, the stone is extracted in the sac from the 10 mm port and afterwards a small drain was inserted through the other 5 mm port.
Swelling or pus draining from the site of incision, Fever with chills, Nausea, Excessive bleeding, Redness and vomtings are the side effect after the operation.
Home care must be taken like taking rest for 5 -7 days after the surgery (after patient can resume normal daily activities), consuming plenty of fluids, Cleaning the incision sites as per the instructions given in the hospital and taking medications as per the advice of the doctor.