Double‐J stent placement during laparoscopic ureterolithotomy: the “seagull” technique

Abstract

Objective To present a new technique of double‐j stent (DJ) placement during laparoscopic transperitoneal ureterolithotomy (LUL). Patients and methods Following the extraction of the stone, a 6 French DJ open‐end stent is prepared: two straight‐tip hydrophilic guidewires are inserted into the appropriate lateral holes of the stent, as identified by the preoperative evaluation of the CT scan. Approximately 5 centimeters of each wire protrude from the proximal and distal ends of the stent to straighten its terminal curl, thus resembling the wings of a flying seagull. The remaining proximal portions of both guide wires are left within each guidewire dispenser. The two ends of the stent are grasped together in a U‐fashion and inserted into the abdomen through a 10mm port. Once in the abdomen, the longer segment of the stent is inserted and pushed into the ureterotomy until it reaches the target site. The guide wire is then removed. The same procedure is repeated for the other end of the stent. A brief literature review on the currents techniques of laparoscopic DJ placement is also presented. Results Analyzing the outcomes of 21 LUL, the "seagull" technique is time‐saving and safe. No perioperative complications were encountered. There is no risk of enlarging or tearing the ureterotomy and no need for patient replacement, extra cystoscopic or ureteroscopic procedures as well as of using modified guidewires and closed‐tip stents. Conclusion We described our step‐by‐step technique for DJ placement during LUL.

The ‘amphisbaena’ procedure facilitates antegrade JJ stenting during laparoscopic ureteric reconstruction

“…This technique might damage the ureter by introducing the stent through two broken ends of the ureter in opposite directions. A similar method involves inserting two guidewires into the JJS through two lateral side holes, then removing the two guidewires after the two ends of the JJS sequentially reach the target sites [5]. It is worth noting that the above-mentioned two methods involve the extra cost of another guidewire.…”

“…Antegrade JJS placement is easily performed in open surgery, however, the procedure becomes challenging in laparoscopic operations even in the era of robotic surgery. Although several antegrade JJS placement methods were proposed previously [1,[3][4][5], there is still much room for improvement.…”