Evaluation of laparoscopic retroperitoneal surgery in urinary stone disease

Purpose: To assess the safety and effectiveness of laparoscopic retroperito neal surgery and attempt to define its role in the management of urolithias is. Patients and Methods: Laparoscopic retroperitoneal surgery (LRS) was undert aken in 72 male and 42 female patients with calculous disease from March 19 94 to April 2000 for variety of indications that otherwise would have made them candidates for conventional open surgery. Some of these patients were subjected to retroperitoneoscopic ureterolithotomy (RPUL) (40 patients) and retroperitoneoscopic pyelolithomy (RPPL) (7 patients). Retroperitoneoscopi c nephrectomy (R-PN) and nephroureterectomy (RPNUT) for a nonfunctioning re nal unit secondary to renal and or ureteral calculi was done in 53 and 14 p atients, respectively. Most of the procedures were performed with three 10- mm. ports. In some cases, an additional 5-mm port was used. Results: The procedure was successful in 75%, 71%, 90.5%, and 86% of cases subjected to RPUL, RPPL, RPN, and RPNUT, respectively. The mean operating t ime for RPUL was 106.3 minutes and for RPPL was 108.2 minutes, whereas it w as 99.7 minutes for RPN and 147 minutes for RPNUT of nonfunctioning kidneys secondary to calculous disease. The major complications encountered were c olon injury in one patient with calculous pyonephrosis who had dense adhesi ons and injury to the external iliac artery in another patient having RPUL. The mean blood loss was 69.8, 127.2, 135.6, and 206.5 mL, respectively, fo r RPUL, RPPL, RPN, and RPNUT. The average hospital ranged from 3 to 4 days. Conclusions: Laparoscopic retroperitoneal surgery has a definite role in th e management of patients requiring open surgery for calculous; disease. It is safe and feasible in spite of the dense adhesions that are frequently en countered in such patients. Often, previous attempts at treatment with shoc kwave lithotripsy or endourologic procedures also lead to inflammation and adhesions, making surgery difficult. However, these problems can be dealt w ith by LRS with good results.