Editorial Comment for Kim et al.

Antegrade stent placement during laparoscopic upper urinary tract procedures can be challenging, and although it has been shown to reduce postoperative complications, the necessity for routine stent placement is a source of some controversy. ^1,2 In this article, Kim and associates demonstrate a practical new device for antegrade insertion of a Double-J stent during upper urinary tract surgery. They designed a synthetic plastic J-shaped tube through which they passed the stent in an antegrade fashion without any complications, without the need for additional punctures or incisions, and with a mean additional operative time of 4.8 minutes.

Antegrade vs retrograde laparoscopic ureteral stent placement has been studied, but without any consensus of which one is safer or better. ^{3 –8} Different antegrade approaches have been described, including the many difficulties that often make them more time consuming. ^{3 –5} Other studies have used different materials as a guide (Chiba needle, gauge needle) but with extra punctures. ^9,10 We sometime use these techniques, but frequently experience difficulty with the insertion of the guidewire or stent because of looping in the abdominal cavity or lack of progression because of the angle of insertion into the ureter, with the consequence of prolongation of the surgical procedure. The authors emphasized the advantages of this device that probably helps to avoid these problems during laparoscopic stent insertion.

Derouiche and colleagues ⁵ used a bridge operating-guide device for antegrade stent placement, also through a trocar port, with a mean time for stent insertion of 5 minutes. There are no recent updates to this work, however. The use of a plastic material similar to the sheath that houses a guidewire to make the device is fundamental and differentiates it from the work of Derouiche and coworkers ⁵ ; it is likely also cheaper and more readily accessible.

We congratulate the authors for their originality and vision to resolve common problems facing urologists with simple solutions. It is important that the authors continue to explore the applications of this device. We wait for a commercially available device so that the next time this situation arises, we can follow their technique and evaluate the real advantages.