| Objective: Since laparoscope technology was utilized on the medical clinical, the specific advantages of minimally invasion, tissue dissection clear, less postoperative recovery time had made it obtain rapid expansion on the surgical field. The technology was widely utilized and extended on the fields of departments of thoracic surgery, general sugery, gynaecology and obstetrics, urology surgery and so on .The technology had changed better and better through the large of clinicists'uninterrupted practice and increase. It's utilize range was becoming larger and larger, and extended the intrinsical ideal of telescope. The most notable expression of extend the idea is the utilize of laparoscope technology on urology surgery. Most organs of the urinary system located the place of aboral peritoneum, and the place have not the nature space, which had the starting of the utilize of laparoscope technology on urology surgery later than the other subjects. Afterwards the urologist constructed a man-made space through the pressure of gasbag or water sac and the CO2 at the rarefaction place of aboral peritoneum, which made the majority urology telescope surgery can be done through the outside of peritoneum and produced the epochal progress on the field of the utilize of laparoscope technology on urology surgery.Operation on ureter of urology surgery have two ways which are open surgery and endoscopic surgery. Along with the progress of medical iconography and medical equipments, most of ureteric disease can be solved through the endoscopic way. Ureteral calculi usually was solved by operation before, but most these diseases can be cure through in vitro macadam or natural tune calculus removing now. Nevertheless, some ureteric diseases such as abnormalities, stenosis, polyps hyperplasia, huge gallstone obstruction and so on are difficult to solve by intra-cavity medical technology. They still need to be done by open surgery or laparoscopic operation.The middle-superior segment ureter located waist-belly before the greater psoas muscle and behind the peritoneum from first lumbar vertebra to cavitas pelvis. If the patients apply to prone position, the vertical dimension of approach through pars dorsalis is shorter than through belly or the waist. If combining the direct facilitate advantage of open surgery through dorsal approach and the advantage of laparoscopically minimally invasion ,it will have the synergy superiority. In order to promote urinary laparoscope utilize and progress, we studied systemic anatomy and operation simulation and initial utilize the technology to the clinical. First, we searched cadaver example through dorsal approach to get the message of the process, such as, the important tissues configuration and apparent anatomic landmark, in order to know if we can construct the operating space and finish the operation in this field. Get to know how to construction the safe suitable laparoscope operate pathway, the depth of operation instrument need enter. Next, we dissected exposure of the ureter area and basic operation by retroperitoneal laparoscopic through dorsal approach in cadaver example, simulated ureterolithotomy operation and anastomosis. The purpose was identify the length that laparoscopic could reach and the feasibility of the operation. Finally, we used the technology to the clinical to summarized the data, retrospective contracted and observed between the technology and the retroperitoneal laparoscopic ureterolithotomy through waist approach. Then we summaried the technology's superiority in order to research weather the technology have the value of clinical application and spread.Materials:1 We dissected and searched 4 cases or 8 sides cadaver example through dorsal approach ,recorded the dissection message of the process, which can supply the base for the Laparoscopic procedure. Exposured the kidney and middle - superior segment ureter, observed and recorded it's anatomic structure and important adjacents, which supplied for your information to avoid the important organs injures when the operation of laparoscopic or open. 2 We simulated retroperitoneal laparoscopic ureterolithotomy through dorsal approach in cadaver example, surveyed the field that the laparoscopic device can reach and we can operation. Further we simulated the cut open, separation, ligation, anastomoses and operation of place the double J into the ureter.3 we applied the technology into clinical, and operated 20 cases retroperitoneal laparoscopic ureterolithotomy through dorsal approach, valued the modus operandi and operation result, retrospective control study between the approach and through waist approach, made the statistics analysis research, evaluated the operation approach's value of application and spread.Results:1 Through waist dorsal approach process the skin, hypodermis, latissimus dorsi muscle, fascia lumbodorsalis, quadratus lumborum, lateroconal fascia and Perirenal fascia. Researched the data means we can find that the length of the middle - superior segment ureter is about 15cm. The psoas major muscle start from the body of lumber vertebre's lateral and transverse process, trip towards down and a little lateral (like the digital eight) based on the posterior median line. It's upper landscape breadth less than sacrospinous muscle, completely locate under the sacrospinous muscle, The psoas major muscle side is coincident with sacrospinous muscle exoloma when it reach the sacro-ilium level. Both the abdominal aorta and the inferior vena cava were protected by the strong sacrospinalis and vertebra. So if retroperitoneal laparoscopic operation through dorsal approach can be done from extra-approach the sacrospinalis, which should not injure the important nerves, strong muscle, and main vascular .We inserted the hardness manipulator which length equal with the laparoscopic clamp from the costospinal angle on dorsal approach, discovered that the clamp can reach about 15cm downward the ureteropelvic junction assistanced from the clamp's flexible and revolve.2 We simulated retroperitoneal laparoscopic ureter's operation through dorsal approach in cadaver example. We found that the operating space couldn't be established through the method of gasbag- expand. So we associated the method of dissection to establish the operation space about 500ml. We understood that downward the ureteropelvic junction about 15cm can be clearly seen. All the cut open, separation, ligation and anastomoses can be operated successfully. But the double J can't be placed into the downward ureter.3 We operated 20 cases ureterolithotomy through the approach successfully. Among the patients, 12 male, 8 female.The calculus located the place where was about 2—13cm from ureteropelvic junction . The calculus's diameter lie from about 0.5~2.1cm,mean diameter 1.3cm.Operation time was 40~80min. The mean intraoperative blood loss was 25ml (range from 20 to 50ml). The wound drain pipe were pulled out in 2~4d after operation. The time of lying in bed after operation is 1~3d. All patients discharged from hospital 3 to 5 days after surgery and nobody had severity complication. The double J pipe was pulled out in 2mon after operation. We examined the affected side ureter and found it was unobstructive. The insertion of double J pipe was found a little difficult for the prone position patient through laparoscope The ,which was main complication of the technology. So it was possible to place the double J pipe failure for the patient whose inferior segment ureter was narrowed. Some patients can be changed to the lithotomy position and put the double J pipe successfully through the cystoscope, but it was possible the double J pipe can prolapse from the anastomotic stoma and caused to urinary fistula.Conclusion:1 Operation on ureter of the retroperitoneal laparoscopic through dorsal approach apply to the three hole approach is safe and feasible. The access road position : The line midpoint of Twelfth rib and spina iliace's culmination was the optics pathway entrance. And make the point pinnacle to roughly form a isosceles triangle with the lateral edge of sacrospinalis;sacrospinous muscle, two basic angle point was the operation pathway entrance.2 The downward the ureteropelvic junction about 15 cm can be operated through the technology. 3 This technology has the features of safe and convenience ,visual fields clear , slight postoperative pain , short recovery period and operation pose comfortable. Therefore,This way has the use value and the spread value .
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