Laparoendoscopic Single-Site Ureterolithotomy for Upper Ureteral Stone Disease: The First 30 Cases in a Multicenter Study

Abstract

Purpose: We evaluated the usefulness of laparoendoscopic single-site (LESS) ureterolithotomy with a homemade single port device for upper ureteral stones in patients in whom previous shockwave lithotripsy or ureteroscopic stone surgery had failed or the stone was suspected to be impacted.Patients and Methods: LESS ureterolithotomy was performed on 30 patients by using a homemade single port device composed of an Alexis wound retractor and surgical glove. The mean age of the patients was 42.47 +/- 11.15 years (range 24-65 y), and the male-to-female ratio was 13:17. The mean stone diameter was 1.77 +/- 0.47 cm. One patient underwent a bilateral operation for bilateral ureteral stones.Results: The LESS surgery was converted to conventional laparoscopic surgery in one case. The mean operative time was 110.43 +/- 43.75 minutes. The mean length of hospital stay was 3.40 +/- 1.54 days. None of the patients used patient-controlled anesthesia, and none presented with major complications. The visual analog pain scale score improved significantly by postoperative day 7 (from 6.87 +/- 1.61 preoperatively to 1.67 +/- 1.16; P < 0.001), and 28 (93.3%) patients said they were satisfied with the postoperative outcome. Postoperative radiologic evaluation revealed that the stones had been removed completely in 28 cases. There were no cases of urinary leakage.Conclusion: LESS ureterolithotomy using a homemade single port device can be considered to be a feasible and safe alternative to conventional laparoscopic ureterolithotomy.