Retroperitoneal vs transperitoneal laparoscopic lithotripsy of 20-40 mm renal stones within horseshoe kidneys

Figure 2 Key operative steps in representative cases of the retroperitoneal group (A-E) and the transperitoneal group (F-J). In the upper row: (A) The isthmus (i) was supplied by an aberrant artery (a) from the abdominal aorta (aa). (B) The isthmus was completely isolated with a stapler. (C) The isthmus (i) was moved back to expose the ureter (u). (D) At the guideline of the ureter (u), the pelvis (p) was exposed and dissected to remove the stone. (E) A Double-J stent was inserted into the ureter (u). In the bottom row: (F) The isthmus (i) was exposed. (G) Anastomosis of the isthmus (i). (H) The isthmus was dissected by Mayo scissors. (I) The pelvis (p) was exposed and dissected to remove the stone. (J) A Double-J stent was inserted into the ureter (u).