Ureteral laparoscopic surgery

During the past years, laparoscopy has grown in popularity and become an alternative technique for the treatment of certain pathologies in urological practice. Retroperitoneal laparoscopic procedures for ureteral surgery were first attempted by Wickham in 1979: in this case a patient with a ureteral calculus underwent a successful ureterolithotomy; More recently, the introduction of the Gaur balloon has permitted quick dilatation and easier access to the retroperitoneum. However, in comparison, the transperitoneal method offers more space and better vision for identification of anatomical landmarks. In our clinic, we have performed laparoscopic ureteral surgery using the transperitoneal as well as the retroperitoneal approach. For situations requiring reconstructive surgery, we preferred the transperitoneal approach in 3 cases of ureterolysis; 2 diagnostical and 1 therapeutical. On the other hand, the retroperitoneal approach was employed for carrying out 2 pyeloplasty, 1 ureterocutaneostomy and 1 ureterolithotomy. Furthermore, we performed in similar fashion 3 nephroureterectomy and 1 heminephrectomy combined with partial ureterectomy. In 3 cases, transperitoneal nephroureterectomy with transurethral orifice circumcision was carried out. In all patients, laparoscopy revealed low morbidity with low grade postoperative pain and shorter hospital stay. Our experience shows that the progressive use of retroperitoneoscopic surgery can maintain minimal invasiveness and permit good access to various procedures without complications connected to use of the Veress needle or the presence of abdominal adhesions. In addition to our own laparoscopic experience, we have reviewed the literature and report on the most frequent ureteral surgery performed laparoscopically.