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Laparoscopic ureterolithotomy: BASIC TECHNIQUE AND PROBLEMS

3A. Indications for retroperitoneoscopic ureterolithotomy. Ureteral stones not amenable to existing minimally invasive modalitiesImpacted ureteral stones larger than 1.5cmAssociated pathology making the use of alternative minimally invasive procedures difficult or impossible.. 3A. The Basics of RL

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Laparoscopic ureterolithotomy: BASIC TECHNIQUE AND PROBLEMS

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    1. 3A Laparoscopic ureterolithotomy: BASIC TECHNIQUE AND PROBLEMS DD GAUR Bombay Hospital Institute of Medical Sciences, Bombay, India

    2. 3A Indications for retroperitoneoscopic ureterolithotomy Ureteral stones not amenable to existing minimally invasive modalities Impacted ureteral stones larger than 1.5cm Associated pathology making the use of alternative minimally invasive procedures difficult or impossible.

    3. 3A The Basics of RLU Patient position Primary access Ports

    4. 3A Technical details Identify the ureter Dissect the stone bearing ureter Be careful not to dislodge the stone Hold the ureter with a ureteral forceps Incise the ureter over the stone Carefully dissect out the stone Deliver the stone from the ureter Irrigate the ureter Remove the stone Suture the ureter Put a drain, remove ports, close the ports

    5. 3A Our experience of RLU Balloon dissection technique for RLU The indications for 101 procedures Salvage procedure 36 Primary procedure 29 Socio-economic 36

    6. 3A Ureteral Incision Endoknife 65 Diathermy 28

    7. 3A How to deliver from the ureter

    8. 3A Identification: The biggest problem Ureter was identified: Immediately 71 After a lap search 24 After a digital search 6

    9. 3A Does preoperative stenting help in ureteral search? No. Too soft for instrumental or digital palpatory search It only helped in confirming the ID

    10. 3A How to search for the ureter? Digital localization Fluoroscopy Laparoscopic search

    11. 3A To suture or not to suture Sutured and stented 45 Left open 48 Leak: stented/sutured 3.2 days Leak: ureter open/unstented 7.1 days

    12. 3A How to avoid an open conversion? Causes of failure in 8 cases: Stone slipped up 2 Poor pneomo 2 Dense fibrosis 3 Bleeding (fibrosis) 1

    13. 3A How to avoid complications? Bleeding 1 Gross surgical emphysema 2 High fever 2 Hypercarbia 1 Ureteral avulsion 1 Colonic perforation 1

    14. 3A Recent developments in RLU Development of mini access retroperitoneoscopy Simplification of the technique

    15. 3A Simplification of the technique The two step technique not necessary

    16. 3A How to pass a JJ stent retroperitoneoscopically?

    17. 3A Caution! Retroperitoneoscopic ureterolithotomy can be a very tricky procedure

    18. 3A What is the trick up his sleeves?

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