Laparoscopic ureterolithotomy: a comparison between the transperitoneal and the retroperitoneal approach during the learning curve.
OBJECTIVE
To compare the transperitoneal approach and the retroperitoneal approach in the laparoscopic management of ureteral stones, at two different urologic centers during the learning curve period.


METHODS
We prospectively evaluated 35 consecutive laparoscopic ureterolithotomies performed by two different urologists during their learning curve period in laparoscopy. Each surgeon used a different approach: Transperitoneal (group A) and retroperitoneal (group B). Timing for patients' positioning, trocar placement, ureter isolation, stone extraction, and suturing were recorded to compare the transperitoneal with the retroperitoneal method. Intraoperative complications and perioperative morbidity were also reported.


RESULTS
Eighteen procedures were performed using the transperitoneal method (group A) and 17 using the retroperitoneal method (group B). Significant differences between group A and B were observed in terms of time for access to the operating field (mean times 14 and 24 min, respectively, P = < 0.001); time for suturing the ureter (mean times 16 and 28 min, respectively, P = < 0.001); and total operative time (mean times 75 and 102 min, respectively, P = 0.002). No statistical differences were observed for any other parameters. Blood loss was minimal in all cases (mean losses 50 and 45 mL, respectively, P = 0.852); and hemotransfusion was not needed by either group. At the 12-month follow-up, no cases of ureteral stricture were recorded.


CONCLUSIONS
We suggest that urologists in training for laparoscopy perform laparoscopic ureterolithotomy using a transperitoneal route. In expert hands, both transperitoneal and retroperitoneal approaches are feasible, and the choice depends on personal preference.
Bove
Pierluigi
P
Department of Urology, Tor Vergata University, Rome, Italy. pierluigi.bove@uniroma2.it
Micali
Salvatore
S
Miano
Roberto
R
Mirabile
Gabriella
G
De Stafani
Stefano
S
Botteri
Edoardo
E
Giampaolo
Bianchi
B
Vespasiani
Giuseppe
G
D000328:Adult; D006801:Humans; D010535:Laparoscopy; D007858:Learning; D008875:Middle Aged; D005791:Patient Care; D012187:Retroperitoneal Space / Q000601:surgery*; D014513:Ureter / Q000601:surgery*