Transperitoneal laparoscopic and retroperitoneoscopic stone treatment

Abstract

Objectives: This chapter focuses on the role of laparoscopic and retroperitoneoscopic stone surgery, especially in Europe and Northern America, where endourology and shock wave lithotripsy have replaced open stone surgery almost completely but also in developing and emerging nations.There are no absolute indications for laparoscopic or retroperitoneoscopic stone surgery. Relative indications are residual stones after failure of other treatment modalities, very large or hard stones, stones in patients with anatomic variations of kidney and ureter, stones in patients who have to be safely treated within one treatment session, and stones in patients with other pathologies requiring surgical interventions. Preparation and Techniques: Proper imaging and planning are mandatory in every single case. The access to the ureter and kidney (laparoscopic transperitoneal or retroperitoneoscopic) depends on the anatomy, on the localization of the stone, and on the skills and preferences of the surgeon. We propose that an organ bag should be used for removal of the stone from the body to prevent loss of a stone Discussion: We prefer inserting a double-J stent before starting surgery, if possible. However, there is an ongoing discussion whether to stent the ureter or not. The use of thermal energy for opening of the ureter may lead to higher rates of stricture formation; however, this is not verified yet. After removal of the stone, we do an intracorporeal suture to close the ureter and leave a drain as most authors do. Other groups negate suturing of the ureter to prevent stricture formation from too tight sutures. Laparoscopic and retroperitoneoscopic stone removal can be carried out with high stone-free rates and low complication rates in experienced hands. Less postoperative pain, shorter hospital stay, and time to convalescence and better cosmetic results are advantages compared to open surgery; however, operating room times are longer. In Europe and Northern America, retroperitoneoscopic and laparoscopic stone surgery is rarely performed because endourological techniques and shock wave lithotripsy are widespread. However, in developing and emerging nations, there is a large potential for these minimally invasive surgical methods for stone removal in replacing open surgery.Conclusions Despite the advances in endourology and shock wave lithotripsy, open stone surgery is still used in special stone situations. Laparoscopic and retroperitoneoscopic stone removal can be a good alternative to open surgery in most of these cases.