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 urete ral surgery were first attempted by Wickham in 1979: in this case a pa tient with a ureteral calculus underwent a successful ureterolithotomy ; More recently, the introduction of the Gaur balloon has permitted qu ick dilatation and easier access to the retroperitoneum. However, in c omparison, the transperitoneal method offers more space and better vis ion 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 reconst ructive 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 pyelopla sty, 1 ureterocutaneostomy and 1 ureterolithotomy. Furthermore, we per formed in similar fashion 3 nephroureterectomy and 1 heminephrectomy c ombined with partial ureterectomy In 3 cases, transperitoneal nephrour eterectomy with transurethral orifice circumcision was carried out. In all patients, laparoscopy revealed low morbidity with low grade posto perative 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 comp lications connected to use of the Veress needle or the presence of abd ominal adhesions. In addition to our own laparoscopic experience, we h ave reviewed the literature and report on the most frequent ureteral s urgery performed laparoscopically.