Laparoscopic Ureterolithotomy
Laparoscopic Ureterolithotomy is a minimally invasive surgical procedure used to remove large or impacted stones (ureteroliths) from the ureter. It is typically performed when other less invasive methods, such as extracorporeal shock wave lithotripsy (ESWL) or ureteroscopy, are ineffective or inappropriate.
Procedure Overview:
Preparation:
- Preoperative evaluation: Includes imaging studies (CT scan, X-ray, or ultrasound) to locate the stone and assess the urinary tract.
- Anesthesia: General anesthesia is administered.
- Bowel preparation: Sometimes required to clear the bowels before surgery.
Surgical Steps:
- Positioning: The patient is placed in a lateral or supine position, depending on the stone’s location.
- Trocar insertion: Small incisions (typically 3-4) are made in the abdomen, and trocars (surgical ports) are inserted to create access points.
- Insufflation: Carbon dioxide gas is used to inflate the abdominal cavity for better visualization and access.
- Stone removal: The ureter is carefully dissected, and the stone is removed using laparoscopic instruments.
- Stent placement: A ureteral stent may be placed to ensure proper drainage and healing.
- Closure: The incisions are sutured or closed with adhesive strips.
Postoperative Care:
- Pain management and monitoring for complications.
- Stent removal is usually done after a few weeks, depending on recovery.
- Follow-up imaging to ensure complete stone removal.
Advantages:
- Minimally invasive with smaller incisions.
- Faster recovery compared to open surgery.
- Reduced postoperative pain and scarring.
Indications:
- Large stones (>2 cm) that cannot be treated with less invasive methods.
- Impacted stones causing severe obstruction or damage to the ureter.
- Stones associated with infection or failed prior treatments.
Risks and Complications:
- Bleeding or infection.
- Injury to surrounding organs or tissues.
- Urine leakage from the ureter.
- Rarely, recurrence of stones.
