Evaluation of Laparoscopic Retroperitoneal Surgery in Urinary Stone Disease

Hemal, Ashok K.; Goel, Apul; Kumar, Mritunjai; Gupta, Narmada P.

doi:10.1089/08927790152596271

Cited by 56 publications

(35 citation statements)

References 20 publications

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“…Our results were corroborated by the findings of the study conducted by Sinha et al [3] , which reported an average hospital stay of 3.6 days for patients who underwent laparoscopic pyelolithotomy. Similar results were reported by Goel et al [6] in their study, in which the hospital stay for laparoscopic pyelolithotomy patients was 3-4 days. Soares et al [11] reported that, in their study, the average hospital stay was 3 days (range 1-10) for laparoscopic pyelolithotomy patients.…”

Section: Hospital Staysupporting

confidence: 91%

“…Alaa el-ghomeni et al [5] reported an operative time of 135 min for laparoscopic pyelolithotomy. Hemal, Kumar et al [6] reported an operative time of 108.2 min. for laparoscopic pyelolithotomy.…”

Section: Operative Timementioning

confidence: 99%

“…The intra-op complication rate in our study is similar to the complication rates reported in the literature. Goel et al [6] reported a complication involving injury to a patient's colon with a calculous pyonephrosis that had dense adhesions in their study of laparoscopic pyelolithotomy.…”

Section: Intra-operative Complicationsmentioning

confidence: 99%

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Laparoscopic retroperitoneal pyelolithotomy and open pyelolithotomy: a comparative study

Patloo¹,

Sarmast²,

Khan³

et al. 2012

Turkish Journal of Urology

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Objective: To compare the outcomes of laparoscopic pyelolithotomy and open pyelolithotomy at a single center in terms of operative time, blood loss, intra-and post-operative complications, analgesia requirements, hospital stay, convalescence and cosmesis. Material and methods:This prospective randomized study was conducted in the Department of Surgery of the Government Medical College Srinagar between May 2008 and September 2010. Sixty patients underwent pyelolithotomy during this period, including both open pyelolithotomy (n=30) and laparoscopic retroperitoneal pyelolithotomy (n=30). All patients (age >14 yr) with large (>1.5 cm) renal pelvic stones who met the inclusion criteria were included in the study. The decision to perform open or laparoscopic pyelolithotomy was made randomly by a computer program. Results:The majority of our patients in both study groups were in the 21-40 yr age group. The mean operative time was significantly less (p<0.001) in the open group than in the laparoscopic group (74.83 min vs. 94.43 min). The mean blood loss was less in the laparoscopic group than in the open group (73 mL vs. 103 mL); however, this difference was not statistically significant. In the laparoscopic group, both the resumption of oral intake (10.33 hrs vs. 15.60 hrs) and the drain removal (2.7 days vs. 3 days) occurred earlier, although these differences were not significant. Intraoperative complications occurred more frequently in the laparoscopic group (16% versus 6.66%); however, all of the complications were minor and were managed intraoperatively in the same sitting. There was no statistically significant difference in the postoperative pain scores or analgesia requirements, and postoperative complications were only slightly more frequent in the laparoscopic group in our study. The mean hospital stay in the open group was 5.2 days, while the mean stay of the laparoscopic group was 3.8 days (p<0.03). Patients in the laparoscopic group returned to their routine activities significantly earlier (1.78 vs. 3.83 wks) than did patients in the open group (p<0.001). Conclusion:Laparoscopic retroperitoneal pyelolithotomy for upper urinary tract calculi is superior to open surgery because of the significantly reduced hospital stays and cosmetic outcomes of patients who underwent the laparoscopic surgery. Although the reductions of analgesia requirements and blood loss were not statistically significant in our study, the data still favored the laparoscopic procedure. Disadvantages of retroperitoneal laparoscopy include the decreased working space, the cost of equipment and the availability of a trained surgeon.

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Section: Hospital Staysupporting

confidence: 91%

Section: Operative Timementioning

confidence: 99%

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Laparoscopic retroperitoneal pyelolithotomy and open pyelolithotomy: a comparative study

Patloo¹,

Sarmast²,

Khan³

et al. 2012

Turkish Journal of Urology

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“…Hamal et al [25] reported a success rate of 75% in their LRU series and explained that open conversion occurred early in their work and was related to the stepwise learning curve. Also, Jeong et al [26] reported a high rate of change to open surgery (50%) as they opened 6 of 12 patients due the failure of ureter identification because of adhesion and periureteritis in 5 patients and vascular injury in 1.…”

Section: Discussionmentioning

confidence: 99%

Laparoscopic ureterolithotomy; which is better: Transperitoneal or retroperitoneal approach?

Khalil¹,

Omar²,

Abdel-baky³

et al. 2015

Turkish Journal of Urology

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Objective: This was a prospective study to compare the outcome of laparoscopic transperitoneal ureterolithotomy (LTU) with laparoscopic retroperitoneal ureterolithotomy (LRU) as a primary treatment for a large stone in the proximal ureter. Material and methods:A total of 24 patients with a solitary, large (>1.5 cm), and impacted stone in the proximal ureter was selected and randomly divided into two groups. The first group included 13 patients who were treated by LTU, and the second group included 11 patients who were treated by LRU. Patient demographics and stone characteristics as well as the operative and postoperative data of both groups were compared and statistically analyzed.Results: There was no significant difference between the two groups regarding patient demographics and stone characteristics. The mean operative time was significantly shorter in the LTU group than in the LRU group [116.2±21.8 min vs 137.3±17.9 min, respectively (p=0.02)]. The mean time to oral intake was significantly longer in the LTU group than in the LRU group [21.2±4.9 h vs 15.5±2.8 h, respectively (p=0.002)]. There was significant higher rate (27.3%) of changing to open surgery in LRU (p= 0.04). The stone-free rate was significantly higher in the LTU group than in the LRU group [100% vs. 72.8%, respectively (p=0.03)]. There was no statistically significant difference between the two groups regarding the mean blood loss, mean hospital stay, mean analgesia dose, blood transfusion rate, postoperative fever, and stone migration during surgery. Conclusion:Both approaches of laparoscopic ureterolithotomy are effective in treating large impacted stones in the proximal ureter. LTU has significantly shorter operative time and lower rate of open conversion but has a significantly longer time to oral intake.

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“…16 Recently, successful laparoscopic management of renal stones has been described; however, the indications have not yet been defined and outcomes have not been compared with established techniques, such as PNL. 17,18 In the current study, LPL was evaluated as a surgical monotherapy to manage renal pelvic stones and compared with PNL. In our study, the preoperative data of both groups were homogenous with no statistically significant difference regarding age, sex and stone size.…”

Section: Discussionmentioning

confidence: 99%

Comparative study of laparoscopic pyelolithotomy versus percutaneous nephrolithotomy in the management of large renal pelvic stones

Haggag

Morsy

Badr

et al. 2013

CUAJ

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Background: The aim of the study is to investigate whether laparoscopic pyelolithotomy (LPL) could be used to manage large renal pelvic stones, generally considered excellent indications for percutaneous nephrolithotomy (PNL). Methods: This study was performed from May 2009 to March 2012 at Al-Azhar University Hospitals (Assiut and Cairo), Egypt. It included two groups of patients with large renal pelvic stones; only patients with stones 2.5 cm 2 or greater were included. Group 1 included 40 patients treated by PNL and Group 2 included 10 patients treated by LPL. The differences between the two procedures were compared and analyzed. Results: There was no difference between the two groups regarding patient demographics and stone size. There was a statistically significant difference between the groups regarding mean estimated blood loss (65 ± 12.25 [range: 52.75-77.25] vs. 180 ± 20.74 [range: 159.26-200.74] mL, p ≤ 0001), mean hospital stay (2.3 ± 0.64 [range: 1.66-2.94] vs. 3.7 ± 1.4 [range: 2.3-5.1] days, p ≤ 0.006), rate of postoperative blood transfusion (0% vs. 4.8%, p ≤ 0.0024), and stone-free rate (80% vs. 78.6%, p ≤ 0.23). The mean operative time was significantly longer in Group 2 (LPL) (131 ± 22.11 [range: 108.89-153.11) vs. 51.19 ± 24.39 [range: 26.8-75.58] min, p ≤ 0001), respectively. Conclusion: Although PNL is the standard treatment in most cases of renal pelvic stones, LPL is another feasible surgical technique for patients with large renal pelvic stones. IntroductionWith the advances in shock wave lithotripsy (SWL) and endourological procedures, such as percutaneous nephrolithotomy (PNL) and ureterorenoscopy (URS), the treatment of urinary stone disease has changed markedly. The indications for open renal surgery to treat renal calculi are limited to special situations; it is needed in only 0.47% to 5.4% of the time.1-4 To treat renal calculi of 2.5 cm 2 or larger in diameter, PNL has been used successfully. With low complication rates, PNL has been accepted as first-line therapy. There are some advantages to laparoscopy despite to its rarity and limited indications. However, advanced experience and high skills are needed for the laparoscopic management of complex stones, such as anatrophric nephrolithotomy. 6,7 With the increase in stone size, success, complications and additional treatment rates differ in patients treated with PNL. 8In centres with established experience in advanced reconstructive laparoscopy, LPL can be a feasible alternative to PNL. 9 In this study, we compared PNL versus LPL in large pelvic stone and investigated the role of LPL. MethodsFrom May 2009 to March 2012, 10 patients with large renal pelvic calculi (2.5 cm 2 or more) were treated with LPL. In the same period, PNL was performed in 42 patients (2 patients had staged bilateral PNL and we therefore excluded from the analysis). An informed written consent was taken from each patient.All patients were documented prospectively in our database. We tallied age, stone location and size. Preoperative complete blood...

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Evaluation of Laparoscopic Retroperitoneal Surgery in Urinary Stone Disease

Cited by 56 publications

References 20 publications

Laparoscopic retroperitoneal pyelolithotomy and open pyelolithotomy: a comparative study

Laparoscopic retroperitoneal pyelolithotomy and open pyelolithotomy: a comparative study

Laparoscopic ureterolithotomy; which is better: Transperitoneal or retroperitoneal approach?

Comparative study of laparoscopic pyelolithotomy versus percutaneous nephrolithotomy in the management of large renal pelvic stones

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