Cirugía laparoscópica para el tratamiento de la litiasis del uréter lumbar

Introduccion: La cirugia laparoscopica ha remplazado paulatinamente la abierta. Actualmente se emplea para la remocion de calculos ureterales y renales. La ureterolitotomia laparoscopica (UL) es considerada relativamente facil y se ha empleado tanto el abordaje transperitoneal como retroperitoneal. Este grupo ha considerado el abordaje retroperitoneal por sus ventajas. Metodologia: Se realizo un estudio prospectivo y descriptivo en el Centro Nacional de Cirugia de Minimo Acceso (CNCMA) desde 2011 a 2013, en una serie de 57 pacientes con litiasis localizada en el ureter lumbar, mayores de 1,5 cm, enclavadas,  o con fallo del tratamiento previo mediante litotricia extracorporea o la ureteroscopia. Se realizo un abordaje retroperitoneal, se emplearon tres trocares y optica de 0°, coagulacion monopolar para la incision ureteral y cateter ureteral JJ. Resultados: Predomino el sexo masculino y la edad media fue 46,5 anos. La litiasis estaba impactada en todos los pacientes, en la mayoria localizada en el ureter lumbar alto y el 71,92% era mayor de 1,5 cm. El tiempo quirurgico fue 96,4 minutos. Las perdidas sanguineas fueron minimas. La estancia hospitalaria fue 2,6 dias. La ULL fue factible en el 100% y el 98,2% quedo libre de litiasis (resolutividad). No se produjeron complicaciones transoperatorias. 15,7% tuvieron complicaciones postoperatorias y el 8,7%, correspondio a infeccion urinaria. Dos pacientes tuvieron complicaciones grado III. Conclusiones: La ULL es una alternativa con resultados satisfactorios para la litiasis grandes y enclavadas del ureter lumbar. Es factible, con alta resolutividad y baja morbilidad. Palabras claves: litiasis ureteral, ureterolitotomia, retroperitoneoscopia, cirugia laparoscopica Introduction: Laparoscopic surgery has gradually replaced open surgery. Nowadays, it is used to remove ureteral and renal stones. Laparoscopic ureterolithotomy (LUL) is considered relatively easy and has been used in both transperitoneal and retroperitoneal approaches. This work group has considered the retroperitoneal approach because of its advantages. Method: A prospective and descriptive study was carried out in The Urology Deparment at the National Center for Minimally Invasive Surgery (NCMIS) between 2011 and 2013, in a series of 57 patients with lithiasis located in the lumbar ureter, ≥ 1 cm, impacted, or with failed extracorporeal lithotripsy treatment or ureteroscopy. A retroperitoneal approach was performed, three trocars and 0° optic were used, and monopolar clotting for the ureteral incision and ureteral JJ catheter. Results: Male sex prevailed and average age was 46, 5 years. Lithiasis was localized in the upper lumbar ureter in most and 71, 92% were > 1,5 cm. Operative time was 96,4 minutes. Blood loss was minimal. Hospital stay was 2,6 days. LUL was 100% feasible and 98,2% were free from lithiasis (resolution). There were no transoperative complications. There were 15,7% postoperative complications and 8,7% were due to urinary infection. Two patients had grade III complications. Conclusions: LUL is a feasible and successful alternative for large and impacted lithiasis in the lumbar ureter, with high resolution and low morbidity. Keywords: ureteral lithiasis , ureterolithotomy, retroperitoneoscopy, laparoscopic surgery