Laparoscopic Retro-peritoneal Surgery in the Management of Upper Ureteric and Renal Pelvic Stones: An Evaluation from a Teaching Institute from North India

Background: The purpose of the study of laparoscopic retro-peritoneal surgery in the management of upper ureteric and renal pelvic stones was to evaluate the safety and efficacy of this recommended technique and to investigate that minimal invasive surgery is an alternative method in the current era of endoscopic procedures.

Aims and Objectives: The current study was aimed to share our experience with laparoscopic retro-peritoneal approach for the management of upper ureteric and renal pelvic stones in the face of non availability of Extra-corporeal shock wave lithotripsy (ESWL) Percutaneous nephrolithotomy (PCNL) and Uretrorenoscopy. The observed data was evaluated vis-a-vis the patient profile with respect to age, sex and presenting side, complications, operative time, time to resumption of oral intake, postoperative hospital stay, convalescence, wound infection and Conversion to open technique.

Materials and Methods: The study was under taken in our teaching institute in the Post Graduate Department of General and Minimal Access Surgery in a Medical College setting. The study was completed in a span of 5 years from Feb. 2012 to Feb. 2017. A total of 120 patients were enrolled in the study, admitted directly from our outpatient department. The evaluation and assessment of all these patients was done on the Out patient basis with reference to their indication and suitability for laparoscopic retro-peritoneal modality of treatment.

Results: The study revealed the promising results with reference to the observations made. An analysis of the data collected over the period of 5 years of these patients showed that the majority of our patients were males i.e 85(70.8%) and rest 35(29.16%) patients were females. Interestingly patients in the age range of 3rd to 4th decade reported with stone disease. The study sample was divided into two groups. Group A comprised of the patients who underwent Laparoscopic pyelolithotomy (N=72) and Group B underwent Laparoscopic ureterolithotomy (N=48).Around 69 (57.5%) cases presented with right sided involvement and 51 (42.5%) left side involvement. The operative time calculated on an average was 80.6 minutes (range 60-120 minutes) for pyelolithotomy and 70 minutes (range 50-90 minutes) for ureterolithotomy. The post operative stay on an average was 2.1 days (range 2-7 days)in the ureterolithotomy group and 2.4 days (range3-11 days) in the pyelolithotomy group. The conversion rate in our study due to one or other problem was more for ureterolithotomy group (4 case=8.3 %) than for pyelolithotomy group (5 case=6.9%).

Conclusion: We recommend that laparoscopic retro-peritoneal technique is an excellent tool in the hands of an expert laparoscopic surgeon especially for stones that are not amenable to endoscopic procedures and shock wave therapy. It may also score an edge over the circumstances where either the endoscopic facilities are not available or the patient is not fit for them.