Bove Pierluigi, Micali Salvatore, Miano Roberto, Mirabile Gabriella, De Stafani Stefano, Botteri Edoardo, Giampaolo Bianchi, Vespasiani Giuseppe
Department of Urology, Tor Vergata University, Rome, Italy.
J Endourol. 2009 Jun;23(6):953-7. doi: 10.1089/end.2008.0055.
To compare the transperitoneal approach and the retroperitoneal approach in the laparoscopic management of ureteral stones, at two different urologic centers during the learning curve period.
We prospectively evaluated 35 consecutive laparoscopic ureterolithotomies performed by two different urologists during their learning curve period in laparoscopy. Each surgeon used a different approach: Transperitoneal (group A) and retroperitoneal (group B). Timing for patients' positioning, trocar placement, ureter isolation, stone extraction, and suturing were recorded to compare the transperitoneal with the retroperitoneal method. Intraoperative complications and perioperative morbidity were also reported.
Eighteen procedures were performed using the transperitoneal method (group A) and 17 using the retroperitoneal method (group B). Significant differences between group A and B were observed in terms of time for access to the operating field (mean times 14 and 24 min, respectively, P = < 0.001); time for suturing the ureter (mean times 16 and 28 min, respectively, P = < 0.001); and total operative time (mean times 75 and 102 min, respectively, P = 0.002). No statistical differences were observed for any other parameters. Blood loss was minimal in all cases (mean losses 50 and 45 mL, respectively, P = 0.852); and hemotransfusion was not needed by either group. At the 12-month follow-up, no cases of ureteral stricture were recorded.
We suggest that urologists in training for laparoscopy perform laparoscopic ureterolithotomy using a transperitoneal route. In expert hands, both transperitoneal and retroperitoneal approaches are feasible, and the choice depends on personal preference.
在两个不同的泌尿外科中心学习曲线期内，比较经腹途径和后腹腔途径在腹腔镜治疗输尿管结石中的应用。
我们前瞻性评估了两位不同泌尿外科医生在腹腔镜学习曲线期内连续进行的35例腹腔镜输尿管切开取石术。每位外科医生采用不同的途径：经腹（A组）和后腹腔（B组）。记录患者体位摆放、套管针置入、输尿管分离、结石取出及缝合的时间，以比较经腹与后腹腔方法。还报告了术中并发症和围手术期发病率。
采用经腹方法（A组）进行了18例手术，采用后腹腔方法（B组）进行了17例手术。A组和B组在进入手术视野的时间（平均时间分别为14分钟和24分钟，P = < 0.001）、输尿管缝合时间（平均时间分别为16分钟和28分钟，P = < 0.001）和总手术时间（平均时间分别为75分钟和102分钟，P = 0.002）方面存在显著差异。其他任何参数均未观察到统计学差异。所有病例失血均极少（平均失血量分别为50毫升和45毫升，P = 0.852）；两组均无需输血。在12个月的随访中，未记录到输尿管狭窄病例。
我们建议接受腹腔镜培训的泌尿外科医生采用经腹途径进行腹腔镜输尿管切开取石术。在专家手中，经腹和后腹腔途径都是可行的，选择取决于个人偏好。
