V1722: The New Technique to Insert a Double-J Stent Conveniently in Laparoscopic Ureterolithotomy: Noh&[prime]s method

Video

Introduction and Objectives
Stenting after laparoscopic ureterolithotomy is difficult because of the curls and pliability of the double-J stent. Anterograde placement of the double-J stent during laparoscopic ureterolithotomy is technically, demanding and time consuming. We report a new, time-saving method to antegrade insertion of a double-J stent that we use in laparoscopic ureterolithotomy.

Methods
We conducted a retrospective study between March 2010 and September 2011 on 30 patients who underwent laparoscopic urterolithotomy. All patients were operated on using the new technique of stenting the ureter during laparoscopic ureterolithotomy by modifying the guidewire. To make the procedure easier, we have devised a double-J stent, closed at both ends. For this procedure, two guidewires have to be used. We measure the distance from the urinary bladder to the stone by abdomen CT and also measure the distance from the renal pelvis to the stone. Then, we mark the location of the sidehole of the double-J stent for guidewire insertion by the length that we measured previously. We measure the length from the upper end of the stent to the sidehole and again measure the length from the lower end of the stent to the sidehole which was already marked. We cut the guidewire 5cm longer than the length of the previous measurement from the soft tips of the guidewire with scissors. The guidewire is passed from the sideholes in the stent, leaving about 5cm of the wire outside the stent lumen. Holding the distal end of the double-J stent, we push it in distally. The other end of the double-J stent is pushed in proximally following the same procedure. After placement of the double-J stent in the ureter, we grasp soft side of the guidewire and then remove.

Results
The stent was correctly placed in all cases in less than 5 minutes without any difficulty even if it was the first time. Using this technique, the operating time was markedly shorter than other method described in the literature.

Conclusions
Our new technique, so called Noh&[prime]method, during laparoscopic ureterolithotomy is easier, safer and saves precious time.

Funding: NONE