title: Hand-assisted laparoscopic ureterolysis to treat ureteral obstruction secondary to idiopathic retroperitoneal fibrosis: assessment of a novel technique and initial series.
abstract: OBJECTIVE
  To describe a novel technique and assess an initial series of hand-assisted laparoscopic ureterolysis for the treatment of retroperitoneal fibrosis.
  
  
  METHODS
  Five patients (3 women and 2 men, mean age 56.4 years) with ureteral obstruction secondary to retroperitoneal fibrosis underwent bilateral hand-assisted laparoscopic ureterolysis with biopsy. These patients had undergone an imaging evaluation with excretory urography, computed tomography, furosemide washout nucleotide scan, and/or magnetic resonance imaging. All had ureteral stents placed before or at surgery. A periumbilical hand port, bilateral 10-mm perirectal camera ports, and bilateral 5-mm or 10-mm working ports were placed. The ureters were completely mobilized and placed intraperitoneally. The patient demographic, operative, and early and late postoperative data were collected.
  
  
  RESULTS
  The average operating room time was 259 minutes (range 215 to 300), and the estimated blood loss was 80 mL (range 50 to 200). The mean hospital stay was 4.20 days (range 3 to 5). One minor intraoperative ureteral injury and no postoperative complications occurred. The mean analgesic requirement was 45.6 mg morphine sulfate (range 20 to 88). Three patients also received 120 mg of parenteral ketorolac. All indwelling ureteral stents were removed by 2 to 4 weeks postoperatively. At 22.4 months (range 12 to 29) postoperatively, 90% of the renal units were unobstructed.
  
  
  CONCLUSIONS
  Hand-assisted laparoscopic ureterolysis is an effective minimally invasive technique with less morbidity than open ureterolysis. It offers a shorter operative time and is less technically challenging than conventional laparoscopy. It is our preferred surgical approach for obstructive retroperitoneal fibrosis.
authors.affiliation: Division of Urology, Medical College of Georgia, Augusta, Georgia 30912-4050, USA. jimbrown@mcg.edu
authors.forename: James A
authors.initials: JA
authors.lastname: Brown
authors.forename: Cristopher J
authors.initials: CJ
authors.lastname: Garlitz
authors.forename: Scott G
authors.initials: SG
authors.lastname: Hubosky
authors.forename: Leonard G
authors.initials: LG
authors.lastname: Gomella
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D007431:Intraoperative Complications; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012185:Retroperitoneal Fibrosis / Q000150:complications*; D015607:Stents; D014513:Ureter / Q000601:surgery*; D014517:Ureteral Obstruction / Q000209:etiology / Q000601:surgery*