腹腔镜输尿管切开取石术

                               
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Laparoscopic ureterolithotomy is an alternative to open surgery for removing large stones not amenable to endoscopic treatment. In most of the published literature, laparoscopic approach for lower ureteric stone is described to be less successful than middle and upper ureter.Upper and mid ureteric stones are safely approached retroperitoneally but lower ureteric stones are better approached transperitoneally.As soon as colon was reflected, iliac vessels were identified and then it became easy to identify the ureter, which was then circumscribed with the vascular loop. Ureter was then dissected distally staying away from the adventitia till the stone site was reached. Superior vesical artery was also encountered in both the cases, which could safely be sacrificed.
Conclusion::
With modified technique of laparoscopic stenting and ureteral pinching and port placement strategy, lower ureteric stones could be well treated with transperitoneal laparoscopic approach.

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