Retroperitoneal laparoendoscopic single-site ureterolithotomy for upper ureteral stone disease

Objective. The aim of this article was to present this group's clinical experience with retroperitoneal laparoendoscopic single-site (LESS) ureterolithotomy for the management of upper ureteral stones in selected patients. Material and methods. From May 2011 to November 2012, retroperitoneal LESS ureterolithotomy was performed in 22 patients at Xiangya Hospital. During the operation, a transverse skin incision was made approximately 2.5 cm in length along the lower margin of the 12th rib at the midaxillary line, and a single port was inserted. Standard steps of a multisite retroperitoneoscopic ureterolithotomy with a combination of conventional straight instruments and bent instruments were performed. Results. All cases were completed successfully without conversion to standard laparoscopy or open surgery. No additional ports or expensive flexible instruments were required. Overall, mean operative time was 98.5 min (range 76-174 min) and mean estimated blood loss was 33.4 ml (range 18-53 ml). Mean hospital stay after surgery was 3.7 days (range 3-5 days). One patient had fever postoperatively due to an Escherichia coli urinary tract infection, which resolved with appropriate antibiotic therapy. There were no major complications. The mean follow-up period was 10.5 months (range 3-21 months). All patients were asymptomatic and did not exhibit signs or symptoms of obstruction or stricture. Conclusions. Retroperitoneal LESS ureterolithotomy is a feasible, safe and effective surgical method for the treatment of upper ureteral stones in select patients. Prospective studies based on more patients are needed to evaluate further its advantages over conventional laparoscopic ureterolithotomy.