Extraperitoneal Versus Transperitoneal Approach of Laparoscopic Ureterolithotomy in Selected Patients
Wisoot Kongchareonsombat MD*, Sahachart Atichoksakun MD*, Kittinut Kitvikai MD*, Suthep Patcharatrakul MD*, Suchart Chaimuengraj MD*
Affiliation : * Division of Urology, Department of Surgery, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
Objective : To evaluate laparoscopic ureterolithotomy between extraperitoneal and intraperitoneal approach in patients with
failure for Extracoporeal shock wave lithotripsy (ESWL) and endoscopic procedure of stone removal.
Material and Method: A retrospective review was performed in 39 patients (40 stone units) underwent laparoscopic
ureterolithotomy (extraperitoneal or intraperitoneal approach) in Ramathibodi Hospital between July 1997 and December
2007. The patients who had a large, impacted ureteric stone more than 1.5 cm or after failure of ESWL and endoscopic
procedure were included. The data was collected and compared in operative time, estimated blood loss (EBL), duration of
retaining drain (days) and complications.
Results : The EBL, operative time and duration of retaining drain were 100 cc, 125.8 minutes and 3 days in the extraperitoneal
group and 51 cc, 128 minutes and 5.8 days in the intraperitoneal group, respectively. The duration of retaining drain in the
transperitoneal group was significant longer than the extraperitoneal group (p = 0.002). The EBL, operative time and
complication were not significantly different between the two groups.
Conclusion : There does not seem to be a clear advantage to using a transperitoneal versus extraperitoneal approach for
laparoscopic ureterolithotomy, depending on physician preference.
Keywords : Laparoscopic ureterolithotomy, Extraperitoneal, Intraperitoneal, Outcomes
