Most stones of the kidney and ureter are treatable with either lithotripsy (shock-waves are generated by a machine outside the body and focused through tissue onto the stone to fragment it) or by endoscopic means (instruments are used via optical scopes which are inserted either through a tube placed in the back as with PCNL or via the bladder as with ureteroscopy). Occasionally, neither is a good option because the stone is either too hard to break or too large to treat in 1 or 2 sessions. Traditional surgery is then usually recommended. Laparoscopic surgery is a relatively new (since 1992) alternative to open surgery which appears to be as effective but avoids the incision of open surgery and therefore makes hospital stay and recovery times shorter.
Laparoscopic stone surgery
Laparoscopy is commonly known as "keyhole surgery”, however although the incisions are small the view is not. Modern equipment produces a wide, bright, clear and magnified view of the operation, often superior to the traditional open approach. In addition, the gas used to distend the abdomen during laparoscopy also reduces bleeding during surgery.
Traditionally the surgical approach to the kidney/ureter requires a 15-25cm incision because the location is difficult to access. The laparoscopic operation is performed through 3 x 5 - 10 mm cuts below the ribs on the side of the abdomen. An internal plastic tube (stent) is inserted into the ureter using a cystoscope (optical scope placed into the bladder) at the start of the operation. The ureter is identified and exposed at the point where the stone has become stuck. It is incised and the stone removed. The ureter is then reconstructed by suturing the edges together again. Rarely technical difficulties may make the operation unable to be completed laparoscopically, if this eventuates conversion to the open procedure may be achieved without difficulty. The likelihood of this happening is less than 5%.
After the operation
Laparoscopy does not eliminate post-operative pain however any discomfort experienced should be easily controlled using the pain-killers you will be prescribed. The expected hospital time is between 2-4 days (compared with 5-8 days following open surgery). The stitches used to close the wounds are buried and will dissolve.
Although the incisions are small, a significant operation has taken place internally and as such you should not undertake strenuous physical exercise, even if you feel like it, until at least 3 weeks (A return to full activities may take 6-12 weeks with an open approach). You may drive as soon as you think you could brake hard and swerve quickly to avoid an accident (typically 2 weeks).
The internal stent is removed under a local anaesthetic using a flexible cystoscope (optical scope introduced into the bladder via the urethra) 4 weeks after surgery. Further follow-up will be different for different people but will likely involve post-operative scans to ensure that the ureter does not scar and may focus on the treatment or prevention of other kidney stones.