採用加爾達考改良仰臥式瓦爾迪維亞擺位之無輻射後腹腔鏡輸尿管取石術併同步逆行性腎臟內結石取石手術

林宇璨、金介文、陳逸軒、林仁泰、余家政

高雄榮民總醫院外科部泌尿外科¹

國防醫學中心三軍總醫院外科部泌尿外科²

國立陽明大學醫學院³

Fluoroless retroperitoneoscopic ureterolithotomy with simultaneous retrograde intrarenal surgery for renal stone extraction in the Galdakao-modified supine Valdivia position

Yu-Tsan Lin^1,3, Chieh-Wen Chin^1,3, I-Hsuan Chen^1,2,3, Jen-Tai Lin^1,3, Chia-Cheng Yu^1,2,3

¹ Division of Urology, Department of Surgery, Kaohsiung Veterans General Hospital

² Division of Urology, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center

³ School of Medicine, National Yang-Ming University

Objective: 

Laparoscopic ureterolithotomy has become an alternative treatment option for large proximal and middle ureteral stones. As the patient had ipsilateral renal stones, extracorporeal shock wave lithotripsy would be needed for following treatment. We utilized the Galdakao-modified supine Valdivia (GMSV) positioning to develop a fluoroless technique to extirpate concurrent ureteral and renal stones. Herein, we present our preliminary outcomes of fluoroless retroperitoneoscopic ureterolithotomy with simultaneous renal stone extraction via retrograde intrarenal surgery.

Methods:

Between January 2015 and February 2021, 37 patients with concurrent ipsilateral large proximal ureteral and renal stones were enrolled in the study. Eighteen patients underwent fluoroless retroperitoneoscopic ureterolithotomy with simultaneous RIRS for renal stone extraction in the GMSV position, and another 19 patients received retroperitoneoscopic ureterolithotomy in the full flank position. Perioperative outcomes and follow-up results were evaluated and compared between two groups.

Results and Conclusions:

No immediate complication was encountered in our preliminary results. In comparison with the control group, simultaneous retrograde intrarenal surgery saved the following procedures for ipsilateral renal stones. Consequently, fluoroless retroperitoneoscopic ureterolithotomy with simultaneous renal stone extraction via retrograde intrarenal surgery offers an alternative treatment option for large proximal ureteral stones with ipsilateral renal calculi.