Most ureteral calculi can be managed by exttacorporeal shock wave lithotripsy or semirigid ureteroscopy. The trend has been to prefer ureteroscopy, because most patients will present with acute colic requiring insertion of a double-J stent. However, situations exist in which the transureteral approach could become very cumbersome, resulting in long operation times with the risk of ureteral injury. Such a scenario usually involves large, impacted ureteral stones. For such stones, laparoscopic or retroperitoneoscopic ureterolithotomy might present a viable option.2 Usually the operating times are significantly shorter, the stone can be removed, and the ureterotomy can be sutured. It should be emphasized that by 2013 laparoscopic suturing had become a standard procedure among urologic laparoscopists. Therefore, the authors should not claim the data by Gaur et al from the last century to justify the use of the da Vinci system (Intuitive Surgical, Sunnyvale, CA) for this purpose.
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