TLUL was first described by Raboy et al for a 14 mm distal ureteric cysteine calculus which was not amenable to ureteroscopic laser lithotripsy . Retroperitoneal LUL gained popularity when Gaur et al described their technique of hydraulic balloon dilation that provided quick access to the retroperitoneum . LUL with both transperitoneal and retroperitoneal techniques have been used for large impacted ureteric calculi, with stone size more than 15 mm and it has been found that both approaches are effective. The transperitoneal technique has significantly shorter operative time and lower rate of open conversion but has a significantly longer time to oral intake .
In a case series of synchronous bilateral transperitoneal laparoscopic surgery for renal and ureteric stones, 3 patients underwent B/L laparoscopic pyelolithotomy and a 11-year-old boy underwent right pyelolithotomy for renal pelvis stone and left ureterolithotomy for left upper ureteric calculus; 4 ports were used in these patients . Linhui et al have reported 2 cases of bilateral transumbilical laparoscopic single-site (LESS) surgeries in a single operative session. One patient underwent right ureterolithotomy and left varicocelectomy. The other patient underwent right simple nephrectomy for nonfunctioning kidney due to ureteric calculus and left ureterolithotomy; the total operative time was 340 minutes (120 min and 220 min, respectively) .
But till date, no case of B/L synchronous 3-port TLUL similar to ours has been reported in the literature. The decision to do such a procedure was taken considering the large size of the bilateral ureteric stones, both the kidneys showing adequate function in terms of adequate urine output and also the thin built of the patient which allowed successful completion of the surgery with only use of 3 midline ports. Also if the patient had undergone a metachronous surgery, he would have had to remain with the contralateral PCN for a longer duration affecting his quality of life and the surgeon would have had to deal with intraperitoneal adhesions during the second surgery. Moreover, the requirement to avoid additional operative slots, repeat admission and general anaesthesia to the patient during the difficult times of the coronavirus pandemic, lead the surgeon to think about this innovative idea of B/L synchronous 3-port TLUL, thus providing the patient the maximum benefit of minimally invasive surgery.