RPLU

Under general endotracheal anesthesia, the patients were placed in the lateral decubitus position. A skin incision was made at the tip of the 12th rib and the aponeurosis was bluntly perforated under safe control of both hands. A retroperitoneal working space was created with a self-made expansion balloon that was inserted by pushing the peritoneum forward. Approximately 800 ml of sterile saline solution was injected into the dissection balloon through the transparent channel. The retroperitoneal space was bluntly dissected and the dissection balloon was removed. A 5- or 10-mm trocar was then inserted under the subcostal margin in the anterior axillary line. A 10-mm trocar was also placed above the iliac crest in the midaxillary line and this space was filled with CO₂ pneumoretroperitoneum for the laparoscope (Karl Storz Endoskope, Tuttlingen, Germany). Within the retroperitoneal space the psoas muscle and other important landmarks were easily recognized. The Gerota’s fascia was incised parallel to the psoas muscle. Renal vessels were clearly visible as pulsing. Extraperitoneal adipose tissue was removed and the ureter was recognized on the psoas muscle. The stone location could be identified by a conspicuous bulge as the ureter was dissected. The ureteral wall was longitudinally incised by a cold knife over the bulge and the stone was extracted and removed through the first port. An indwelling double-J ureteral stent was placed through the incision. Intracorporeal suturing was used to close the ureteral incisions with 4–0 absorbable sutures.