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Afterwards, the first working port was replaced with the camera to guide the insertion of the single-use digital flexible ureteroscope (REDPINE, Guangzhou, China) through the second working port. A ureteral polyp was incidentally identified, dissected, and sent for biopsy. The large ureteral stone was extracted through the ureterostomy incision. The ureter was identified and isolated with a Harmonic ultrasonic scalpel (Johnson & Johnson, New Brunswick, NJ, USA). The second working port was inserted at the junction between the anterior axillary line and 2 cm below the 12 th intercostal space.
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The first working port (10 mm trocar) was inserted 2 cm above the superior iliac crest at the mid-axillary line. The camera port (10 mm trocar) was inserted 1 cm below the 12 th intercostal space at the posterior axillary line. The procedure was performed through 3 ports. Under general anesthesia, the patient was placed in a right decubitus position with the left flank facing upwards.
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Preoperative computed tomography, revealing ( A) a left renal calculus, ( B) a right renal calculus, and ( C) a left ureteral stone. Given the patient’s 8-year history of coronary artery disease and myocardial ischemia with poor medical adherence, the urologists decided to perform elective laparoscopic ureterolithotomy, and achieve the removal of both stones within a single session with the aid of a single-use digital flexible ureteroscope. A pre-operative computerized tomography urogram revealed a large proximal ureteral stone (size 2.0×0.8 cm maximum 1726 Hounsfield units, mean 1045 HU) with a small renal stone (size 0.6 cm) in the left urinary tract ( Figure 1). The patient was admitted due to his determination to undergo lithotomy.
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Physical examination was unremarkable for tenderness around the flank region and no biochemical abnormalities were detected. The patient was afebrile and vital signs were stable. The ultrasound was performed 10 days earlier at a local hospital, but the patient complained of having experienced urinary urgency for a year. A 60-year-old man consulted our institute’s urologist with an ultrasonography report that revealed a large left proximal ureteral stone with moderate hydronephrosis, accompanied by bilateral renal stones and prostatic hyperplasia.
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