Choice of surgical access for retroperitoneoscopic ureterolithotomy according to the results of 3D reconstruction of operational zone agreed with the patient: initial experience

INTRODUCTION For the procedure retroperitoneoscopic ureterolithotomy, the problems of access choice and thus visualization with utilizing minimally invasive surgical access (either with gasless single port method or gas insufflation) are solved. The decisions are based on the method of presurgery planning, grounded on matching the patient with a 3D model of the zone of surgical interest reconstructed according to the results of tomographic examination. MATERIAL AND METHODS We used a hardware-software complex (HSC) for virtual modeling of the surgery zone and choosing the optimum points for minimally invasive surgical access. The HSC was recruited to choose optimum surgical access, realize presurgery planning, and estimation of the safety of the way of access chosen. The original method of matching the system of coordinates of a virtual model with the patient was offered. RESULTS 12 patients with the calculus in the upper part of ureter averaging 11.5 (9-14) mm in size underwent gasless retroperitoneoscopic ureterolithotomy with use of the HSC. Mean age of the patients was 36.4 (25-49) years old. The surgeries lasted an average of 35.5 (25-40) minutes. Blood loss was averaged at 55.0 (30-90) ml. Healing by first intention was registered with all the patients. The mean hospitalization time was 6.0 (4-7) days. There were neither any complications nor difficulties, nor conversions from incorrectly chosen surgical access. CONCLUSIONS The choice of the optimum surgical access according to the results of a virtual 3D model of the operation zone, matching the system of coordinates of the model with patient concurrence, and presurgery planning, was effective in cases of gasless single port and with gas insufflation retroperitoneoscopic ureterolithotomy.