Asimakopoulos Anastasios D, Colalillo Gaia, Miano Roberto, Agrò Enrico Finazzi, Farullo Giuseppe, Fuschi Andrea, Pastore Antonio Luigi, Germani Stefano
Unit of Urology, Fondazione PTV Policlinico Tor Vergata, Rome, Italy.
Division of Urology, Department of Surgical Sciences, University of Rome Tor Vergata, Rome, Italy.
BJU Int. 2022 Dec;130(6):839-843. doi: 10.1111/bju.15866. Epub 2022 Sep 12.
To present a new technique of double-j stent (DJ) placement during laparoscopic transperitoneal ureterolithotomy (LUL).
Following the extraction of the stone, a 6 French DJ open-end stent is prepared: two straight-tip hydrophilic guidewires are inserted into the appropriate lateral holes of the stent, as identified by the preoperative evaluation of the CT scan. Approximately 5 centimeters of each wire protrude from the proximal and distal ends of the stent to straighten its terminal curl, thus resembling the wings of a flying seagull. The remaining proximal portions of both guide wires are left within each guidewire dispenser. The two ends of the stent are grasped together in a U-fashion and inserted into the abdomen through a 10mm port. Once in the abdomen, the longer segment of the stent is inserted and pushed into the ureterotomy until it reaches the target site. The guide wire is then removed. The same procedure is repeated for the other end of the stent. A brief literature review on the currents techniques of laparoscopic DJ placement is also presented.
Analyzing the outcomes of 21 LUL, the "seagull" technique is time-saving and safe. No perioperative complications were encountered. There is no risk of enlarging or tearing the ureterotomy and no need for patient replacement, extra cystoscopic or ureteroscopic procedures as well as of using modified guidewires and closed-tip stents.
We described our step-by-step technique for DJ placement during LUL.
介绍一种在腹腔镜经腹膜输尿管切开取石术（LUL）中放置双J支架（DJ）的新技术。
结石取出后，准备一根6F开放式DJ支架：将两根直头亲水导丝插入支架的适当侧孔，这些侧孔通过术前CT扫描评估确定。每根导丝约5厘米从支架近端和远端伸出，以拉直其末端卷曲，使其类似海鸥的翅膀。两根导丝的其余近端部分留在各自的导丝分配器内。将支架两端捏在一起呈U形，通过一个10毫米端口插入腹腔。进入腹腔后，插入支架较长的一段并将其推入输尿管切口，直至到达目标部位。然后取出导丝。对支架另一端重复相同操作。还对目前腹腔镜放置DJ支架的技术进行了简要文献综述。
分析21例LUL的结果，“海鸥”技术省时且安全。未遇到围手术期并发症。不存在扩大或撕裂输尿管切口的风险，无需更换患者、额外的膀胱镜或输尿管镜操作，也无需使用改良导丝和封闭头支架。
我们描述了在LUL期间放置DJ支架的分步技术。
