title: Ureteroscopy-Assisted Laparoscopic Segmental Resection of Ureteral Stricture with a Modified Flank Position: Clinical Experience.
abstract: OBJECTIVE
  To share the surgical technique that possesses the advantage of a perioperative ureteroscope without position change, which allows for a laparoscopic segmental resection of the ureteral stricture to be performed more precisely.
  
  
  METHODS
  Between 2006 January and 2015 December, 10 patients with a ureteral stricture received a laparoscopic segmental resection and ureteroureterostomy in our clinical institute. The etiology included stone, endometriosis, crossing vessel, and idiopathic benign ureteral polyp. With the advance of bilateral lower extremities extended and abducted, 1 assistant used a ureteroscope as a direct guide to the precise location of the stricture affected ureter. Thus, the surgeon was able to perform a more specific resection without an unnecessary excision, which may have compromised the blood supply or increased the tension at anastomosis.
  
  
  RESULTS
  Five patients received the traditional transperitoneal laparoscopic approach, whereas the other 5 patients received a ureteroscopy-assisted laparoscopic segmental resection and ureteroureterostomy. The operating time appears to be no different between the two groups (124 minutes versus 142 minutes, P = .351), and, thus, no additional time is consumed for the ureteroscope procedure. After at least 1 year of follow-up, only 1 patient in the traditional laparoscopic group suffered from recurrence. One patient had a right ureteral stricture due to stone impaction, where with the advantage of a ureteroscope guide without change position, the operator was able to make a limited excision at the affected location. No complications related to the decubitus and bilateral leg in the extended position were noted.
  
  
  CONCLUSIONS
  Ureteroscopy-assisted laparoscopic segmental resection of the ureter without a change in position is a feasible and safe procedure when dealing with a refractory ureter stricture. Although it is convenient, the surgeon should be aware of possible pressure sores at the dependent part.
authors.affiliation: 1 Division of Urology, Department of Surgery, Taichung Veterans General Hospital , Taichung, Taiwan .
authors.forename: Sheng-Chun
authors.initials: SC
authors.lastname: Hung
authors.affiliation: 1 Division of Urology, Department of Surgery, Taichung Veterans General Hospital , Taichung, Taiwan .
authors.forename: Kun-Yuan
authors.initials: KY
authors.lastname: Chiu
authors.affiliation: 1 Division of Urology, Department of Surgery, Taichung Veterans General Hospital , Taichung, Taiwan .
authors.forename: Chen-Li
authors.initials: CL
authors.lastname: Cheng
authors.affiliation: 1 Division of Urology, Department of Surgery, Taichung Veterans General Hospital , Taichung, Taiwan .|2 Department of Research, Taichung Veterans General Hospital , Taichung, Taiwan .
authors.forename: Yen-Chuan
authors.initials: YC
authors.lastname: Ou
authors.affiliation: 1 Division of Urology, Department of Surgery, Taichung Veterans General Hospital , Taichung, Taiwan .
authors.forename: Hao-Chung
authors.initials: HC
authors.lastname: Ho
authors.affiliation: 1 Division of Urology, Department of Surgery, Taichung Veterans General Hospital , Taichung, Taiwan .
authors.forename: Shian-Shiang
authors.initials: SS
authors.lastname: Wang
authors.affiliation: 1 Division of Urology, Department of Surgery, Taichung Veterans General Hospital , Taichung, Taiwan .
authors.forename: Chuan-Shu
authors.initials: CS
authors.lastname: Chen
authors.affiliation: 1 Division of Urology, Department of Surgery, Taichung Veterans General Hospital , Taichung, Taiwan .
authors.forename: Jian-Ri
authors.initials: JR
authors.lastname: Li
authors.affiliation: 1 Division of Urology, Department of Surgery, Taichung Veterans General Hospital , Taichung, Taiwan .
authors.forename: Chun-Kuang
authors.initials: CK
authors.lastname: Yang
authors.affiliation: 1 Division of Urology, Department of Surgery, Taichung Veterans General Hospital , Taichung, Taiwan .
authors.forename: Li-Wen
authors.initials: LW
authors.lastname: Chang
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003251:Constriction, Pathologic / Q000000981:diagnostic imaging / Q000601:surgery; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000000981:diagnostic imaging / Q000601:surgery*; D061646:Operative Time; D056888:Patient Positioning; D011183:Postoperative Complications; D016896:Treatment Outcome; D014517:Ureteral Obstruction / Q000000981:diagnostic imaging / Q000601:surgery*; D018666:Ureteroscopy / Q000379:methods
keywords: laparoscopy; ureter stricture; ureteroscope