An attempt at a percutaneous retroperitoneoscopic approach to ureterolithotomy.

The extensive laparoscopic tubectomy programs organized by the Indian government during 1978-1981 as a measure to curb the population explosion brought some unanticipated problems for the authors. One of these, surgical emphysema, gave the authors the opportunity to explore laparoscopically extraperitoneal appearances. So deliberate retroperitoneal surgical emphysema was created, to isolate the ureter so as to locate the stone in it, and to study the feasibility of its removal via laparoscopy itself. The procedure entails minimal trauma and gives the considerable advantage of clear vision for total removal of stone(s). This procedure offers an alternative to the conventional method and to other, newer methods. The conventional method involves wide exposure with attendant morbidity and prolonged hospital stay. Other newer methods require high-tech multimode prerequisites, such as a extracorporeal shock-wave lithotriptor, ultrasound, screening, software, endourological instruments (including lithotriptor), necessarily supplemented by technical experts in each field. Hence such methods require an institutional arrangement at an exorbitant cost to the patient.