Dergiler / Türk Üroloji Dergisi/Turkish Journal of Urology / 2004 / Cilt: 30 - Sayı: 4
Laparoskopik üreterolitotomi: İlk deneyimlerimiz
- Sayfa
- 457–460
- DOI
- —
Özet
Üreter taşlarının bir çoğu spontan olarak düşmemekte ve genellikle ekstrakorporeal şok dalga taş kırma ile (ESWL) yada üreterorenoskopi (URS) ile tedavi edilmektedirler. Ancak büyük, sert ve impakte üreter taşı olgularında; ilk tedavi seçeneği olarak veya diğer tedaviler başarısız kaldığı durumlarda laparoskopik üreterolitotomi tercih edilebilir. Burada 8 hastalık ilk laparoskopik üreterolitotomi deneyimlerimiz sunulmaktadır. Kliniğimizde Kasım 2003-Haziran 2004 tarihleri arasında 8 hastaya (6 erkek, 2 kadın) laparoskopik üreterolitotomi gerçekleştirildi. Olguların 7’sinde taşlar üst üreter lokalizasyonunda, 1 olguda ise orta üreter lokalizasyonunda idi. İşlem tüm hastalarda ilk tedavi seçeneği olarak uygulandı. Bütün işlemler transperitoneal yol ile 3 adet port (1 adet 10 mm’lik, 2 adet 5 mm’lik) kullanılarak gerçekleştirildi ve tüm hastalara ameliyat öncesi açık uçlu kateter ve işlem sonunda da double J stent yerleştirildi. Taşların ortalama çapı 1.7 cm (1.5-3) olarak ölçüldü. Laparoskopik üreterolitotomiler bütün hastalarda başarıyla gerçekleştirildi. Ortalama operasyon süresi 150 dk (120-180) olarak ölçüldü. Ameliyat sonrası ağrı kontrolü non-steroidal analjezikler ile sağlandı. Hastanede kalış süresi ortalama 3.25 (3-4) gündür. Takip süresi ortalama 4 ay olup (1-8) bu süre içinde hiçbir hastamızda erken yada geç komplikasyona rastlanmadı. Laparoskopik üreterolitotomi etkin ve güvenilir bir yöntem olup, ESWL veya URS’nin başarısız kaldığı veya kalacağı tahmin edilen olgularda iyi bir tedavi seçeneği olarak görülmektedir.
Abstract
Introduction: Since laparoscopic surgery has become widely adopted, every urologic operation has been reported with laparoscopic technique, including laparoscopic ureterolithotomy. Most patients with ureteral calculi that do not pass spontaneously can be treated by either extracorporeal shock wave lithotripsy (SWL), ureteroscopy (URS) or percutaneous nephrolitotomy (PNL). In cases of large, hard and impacted stones or after failure of first line treatments, surgical ureterolithotomy is still indicated. Laparoscopy allows performing this procedure in a minimally invasive manner. Here in we report our initial experiences of laparoscopic ureterolithotomy in 8 patients. Materials and Methods: 8 patients (6 men, 2 women) underwent laparoscopic ureterolithotomy between October 2003 and June 2004 at our institution. The localization of the stones was upper ureter in 7 and middle ureter in 1 patient. The procedure was done as primary treatment in all cases. All procedures were carried out via transperitoneal route by using 3 ports. There were no conversion to open surgery and all patients were rendered as stone-free after a single procedure. Open end catheter was inserted peroperatively and double J stent was inserted postoperatively in all cases. Mean diameter of stones was calculated as 1.7 cm (1.5-3). Results: The mean patient age was 38 years (ranged from 20 to 65). Laparoscopic ureterolithotomy was successfully done in all cases. There were no conversion to open surgery and all patients were rendered as stone-free after a single procedure. Double J stent was inserted in all cases. Mean operation time was 150 minutes (range 120 to 180). Postoperative pain was managed with non-steroidal analgesics. Hospital stay ranged from 3 to 4 days (mean 3.25). Mean follow up time was 4 months (ranged from 1 to 8). There were no early and late complications. Intravenous urography of patients at 3rd month interval after the procedure was determined as normal. Conclusion: Percutaneous surgery, ureteroscopy and extracorporeal shock wave lithotripsy have made open stone surgery for upper and mid ureteral stones a rarity in many centers nowadays. Laparoscopic ureterolithotomy is an important improvement in urologic surgery although the indications are limited. Laparoscopic ureterolithotomy is a safe and effective procedure that enables the urologist to maintain a minimally invasive strategy when first-line treatment have failed or are unlikely to be effective. The laparoscopic approach which is a natural extension of the minimally invasive technique may provide us to perform ureterolithotomy with a way in the modern management of stone disease.