Novel technique(Ramalingam technique)of port site retrograde intra renal surgery through exteriorized ureter during laparoscopy

摘要

Occurrence of significant sized renal calculi along with ureteric pathology is not uncommon.We presented two patients:one with significant sized renal calculi along with lower ureteric stricture,and second case with significant sized renal calculi with primary obstructive mega ureter needing surgery for both the renal calculi and ureteric pathology.In both patients laparoscopy was done,and the ureter was mobilised and divided just above the level of the pathology and exteriorised through the nearest sited port,and retrograde intra-renal surgery(RIRS)was done using flexible ureteroscope and laser.Subsequently laparoscopy was resumed,and ureteric reimplantation directly into the bladder or with a Boari flap was done.The entire procedure was completed in a single stage.This novel technique of exteriorizing the ureter through the laparoscopic port site for flexible ureteroscopy in a case of lower ureteric pathology with renal stone is an advantageous option to manage both pathologies in a single stage.It has a better stone clearance than shock wave lithotripsy and less morbidity than percutaneous nephrolithotomy(PCNL).