Laparoscopic ureterolithotomy

When is it needed?

Laparoscopic ureterolithotomy is the ideal approach to treating large ureter stones. The surgery is highly efficient and safe, avoiding additional damage to the ureter during the procedure, especially in comparison to the ureteroscopic methods of breaking down the stones within the ureter itself.

How is it performed?

In order to perform laparoscopic ureterolithotomy, we require 3 trocars inserted at the most anatomically appropriate and convenient places in the stomach, in order to safely approach the ureter stone. If the surgery is performed extraperitoneally, the access is gained through balloon dilation which forms an artificial space in front of the peritoneum (the inner membrane tissue of the stomach) where then the trocars are inserted. After a longitudinal incision on the ureter at the location of the stone, the stone is then removed in its entirety and placed in an endoscopic bag. Before we stitch the ureter back up, we insert a catheter (such as a double-J stent) depending on a variety of factors.

We also insert an drainage tube in order to monitor and control possible post-operative bleeding, as well as urine secretion. The endoscopic bag is removed through an extended incision made in the best spot of the muscle wall to avoid cutting muscle. The remaining trocars are removed, and the incisions are stitched up.

What are the possible complications?

Complications in laparoscopic ureterolithotomies are extremely rare and carry no additional risks beyond the general risks of laparoscopic surgery, such as the damage of stomach organs or blood vessels. However, these risks are minimal and occur in less than 1% of all patients. Approximately less than 0.5% of laparoscopic ureterolithotomy surgeries require a conversion to the open surgical approach.