TY - JOUR
T1 - Laparoscopic ureterolithotomy
T2 - A comparison between the transperitoneal and the retroperitoneal approach during the learning curve
AU - Bove, Pierluigi
AU - Micali, Salvatore
AU - Miano, Roberto
AU - Mirabile, Gabriella
AU - De Stafani, Stefano
AU - Botteri, Edoardo
AU - Giampaolo, Bianchi
AU - Vespasiani, Giuseppe
PY - 2009/6/1
Y1 - 2009/6/1
N2 - Purpose: To compare the transperitoneal approach and the retroperitoneal approach in the laparoscopic management of ureteral stones, at two different urologic centers during the learning curve period. Materials and Methods: We prospectively evaluated 35 consecutive laparoscopic ureterolithotomies performed by two different urologists during their learning curve period in laparoscopy. Each surgeon used a different approach: Transperitoneal (group A) and retroperitoneal (group B). Timing for patients' positioning, trocar placement, ureter isolation, stone extraction, and suturing were recorded to compare the transperitoneal with the retroperitoneal method. Intraoperative complications and perioperative morbidity were also reported. Results: Eighteen procedures were performed using the transperitoneal method (group A) and 17 using the retroperitoneal method (group B). Significant differences between group A and B were observed in terms of time for access to the operating field (mean times 14 and 24 min, respectively, P = <0.001); time for suturing the ureter (mean times 16 and 28 min, respectively, P = <0.001); and total operative time (mean times 75 and 102 min,respectively, P = 0.002). No statistical differences were observed for any other parameters. Blood loss was minimal in all cases (mean losses 50 and 45 mL, respectively, P = 0.852); and hemotransfusion was not needed by either group. At the 12-month follow-up, no cases of ureteral stricture were recorded. Conclusions: We suggest that urologists in training for laparoscopy perform laparoscopic ureterolithotomy using a transperitoneal route. In expert hands, both transperitoneal and retroperitoneal approaches are feasible, and the choice depends on personal preference.
AB - Purpose: To compare the transperitoneal approach and the retroperitoneal approach in the laparoscopic management of ureteral stones, at two different urologic centers during the learning curve period. Materials and Methods: We prospectively evaluated 35 consecutive laparoscopic ureterolithotomies performed by two different urologists during their learning curve period in laparoscopy. Each surgeon used a different approach: Transperitoneal (group A) and retroperitoneal (group B). Timing for patients' positioning, trocar placement, ureter isolation, stone extraction, and suturing were recorded to compare the transperitoneal with the retroperitoneal method. Intraoperative complications and perioperative morbidity were also reported. Results: Eighteen procedures were performed using the transperitoneal method (group A) and 17 using the retroperitoneal method (group B). Significant differences between group A and B were observed in terms of time for access to the operating field (mean times 14 and 24 min, respectively, P = <0.001); time for suturing the ureter (mean times 16 and 28 min, respectively, P = <0.001); and total operative time (mean times 75 and 102 min,respectively, P = 0.002). No statistical differences were observed for any other parameters. Blood loss was minimal in all cases (mean losses 50 and 45 mL, respectively, P = 0.852); and hemotransfusion was not needed by either group. At the 12-month follow-up, no cases of ureteral stricture were recorded. Conclusions: We suggest that urologists in training for laparoscopy perform laparoscopic ureterolithotomy using a transperitoneal route. In expert hands, both transperitoneal and retroperitoneal approaches are feasible, and the choice depends on personal preference.
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U2 - 10.1089/end.2008.0055
DO - 10.1089/end.2008.0055
M3 - Article
C2 - 19459753
AN - SCOPUS:67749106245
VL - 23
SP - 953
EP - 957
JO - Journal of Endourology
JF - Journal of Endourology
SN - 0892-7790
IS - 6
ER -