Laparoscopic-endoscopic single-site surgery retroperitoneal ureterolithotomy: technique and initial experience.

Objective: Laparoscopic-endoscopic single-site surgery (LESS) is a nearly scarless surgical technique. The aim was to assess the results of our initial LESS retroperitoneal ureterolithotomy (LESS-RU) experience and our technique.

Material And Methods: Primary indication for LESS-RU procedure in this study was obstructive or impacted ureteral stone(s) larger than 15 mm and located in the middle or upper part of the ureter in those patients in whom prior interventions have failed. Eighteen patients underwent LESS-RU for upper or middle ureteric stone by one experienced laparoscopist, between December 2008 and December 2009. Patient characteristics, operative details, complications, use of analgesic medication and time to return to work were recorded.

Results: Eighteen cases were successfully accomplished. The mean patient age was 40.1 yr (19-60 yr), and median BMI was 27.7 kg/m2 (21-32). The mean operative time was 69.9 min (50-150 min), and the mean blood loss was 31.9 mi (20-70 mi). Mean stone size was 18.1 mm (range: 16-22). No patient required morphine for pain relief and the main use of oral analgesics was for two days. In postoperative follow-up there was a minimally scar and good cosmetic results were detected.

Conclusions: LESS-RU proved to be safe and feasible. We think that LESS-RU will take place of laparoscopic ureterolithotomy in the near future with better cosmetic results. Further clinical investigation in comparison to the established techniques should take place to evaluate the outcome of LESS-RU.