Robotic extended pyelolithotomy for treatment of renal calculi: A feasibility study

Vattikuti Urology Institute, Henry Ford Hospital, K-9 Urology, 2799 W. Grand Blvd, Detroit, MI 48202, USA.
World Journal of Urology (Impact Factor: 2.67). 07/2006; 24(2):198-201. DOI: 10.1007/s00345-006-0099-6
Source: PubMed


Percutaneous nephrolithotomy (PCNL) remains the treatment of choice for staghorn renal calculi. Many reports suggest that laparoscopy can be an alternative treatment for large renal stones. We wished to evaluate the role and feasibility of laparoscopic extended pyelolithotomy (REP) for treatment of staghorn calculi. Thirteen patients underwent REP for treatment of staghorn calculi over a 12-day period. Twelve patients had partial staghorn stones and one had a complete staghorn stone. All patients had pre-operative and post-operative imaging including KUB and computed tomography. All procedures were completed robotically without conversion to laparoscopy or open surgery. Mean operative time was 158 min and mean robotic console time was 108 min. Complete stone removal was accomplished in all patients except the one with a complete staghorn calculus. Estimated blood loss was 100 cc, and no patient required post-operative transfusion. REP is an effective treatment alternative to PCNL in some patients with staghorn calculi. However, patients with complete staghorn stones are not suitable candidates for this particular technique.

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Available from: James O Peabody, Jun 22, 2014
    • "Percutaneous nephrolithotomy is the current treatment of choice for large renal stones but robot-assisted extended pyelolithotomy (REP) provides an appealing option in cases of staghorn calculi and in patients undergoing concurrent RAP.[42–43] Hemal and coworkers found that in six patients who underwent REP or robot assisted pyelolithotomy, the mean operative time was 106 minutes and EBL was less than 50 ml in all cases. [44] One patient required conversion to an open procedure because the renal calculus could not be localised. "
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    ABSTRACT: Robotic surgery today has made a successful transition into mainstream clinical urological practice, providing minimally invasive surgical treatment options for complex extirpative and reconstructive procedures. It has particularly dominated urologic pelvic surgery including radical prostatectomy, radical cystectomy, and many gynecologic procedures (Menon M, Hemal AK, J Endourol 18(7):611–619, 2004; Hemal AK, Abol-Enein H, Shrivastava A, Shoma AM, Ghoneim MA, Menon M, Urol Clin North Am 31(4):719–729, 2004; Hemal AK, Kolla SB, Wadhwa P, J Urol 180(3):981–985, 2008]. It has successfully been employed in kidney surgery as well, especially donor nephrectomy, partial nephrectomy, and pyeloplasty for ureteropelvic junction obstruction (UPJO) (Phillips CK, Taneja SS, Stifelman MD, J Endourol 19:441–445, 2005; Gettman MT, Neururer R, Bartsch G, Peschel R, Urology 60:509–513, 2002). While urolithiasis is largely treated with shock wave lithotripsy (SWL) and endourological surgery (ureteroscopy [URS] and percutaneous nephrolithotomy [PCNL]), the role of laparoscopy has been explored as an alternative tool in managing urinary stone disease.Laparoscopic ureterolithotomy proved to be a viable alternative to open surgery, helping avoid incision related morbidity in candidates with impacted, large ureteral calculi which had failed an attempt at endourological management (Hemal AK, Goel A, Kumar M, Gupta NP, J Endourol 15(7):701–705, 2001). Laparoscopic stone surgery soon gained acceptance as a complementary minimally invasive technique, specifically to be used in the occasional case considered for open surgery. Stones in anteriorly placed calyceal diverticulum, pelvic stones in ectopic kidneys, assisting percutaneous access in ectopic kidneys formed some of the other indications for laparoscopic stone interventions (Ramakumar S, Segura JW, J Endourol 14(10):829–832, 2000). The use of laparoscopic pyelolithotomy was avidly contested with some authors extolling its virtues as an alternative to PCNL in medium-sized renal calculi unsuitable for SWL therapy and unfavorable calyceal anatomy (Gaur DD, Trivedi S, Prabhudesai MR, Gopichand M, J Laparoendosc Adv Surg Tech A 12(4):299–303, 2002; Yagisawa T, Ito F, Kobayashi C, Onitsuka S, Kondo T, Goto Y, Toma H, J Endourol 15(5):525–528, 2001); while others, though demonstrating its feasibility, were unable to show its superiority over PCNL vis-à-vis operative time and skill required, cosmesis and relative invasiveness (Goel A, Hemal AK, Int Urol Nephrol 35(1):73–76, 2003).The enhanced reconstructive capabilities of the robotic platform added another dimension to laparoscopic management of stone disease. We first explored the use of robot-assisted renal pelvic calculi retrieval during a concomitant pyeloplasty in February 2003 in Egypt. The experience prompted the genesis of usage of robotic-assisted laparoscopic pyelolithotomy, which resulted in the first large series of robotic extended pyelolithotomy (REP) wherein we focused on stone extraction of large renal calculi (partial staghorn calculi), even a complete staghorn calculus (Badani KK, Hemal AK, Fumo M, Kaul S, Shrivastava A, Rajendram AK, Yusoff NA, Sundram M, Woo S, Peabody JO, Mohamed SR, Menon M, World J Urol 24:198–201, 2006). We were successfully able to deal with such large renal pelvic bulky partial staghorn calculi even in cases with intra-renal pelvis, duplicating the technique of extended pyelolithotomy by developing the intrasinus space of Gil-Vernet (Meria P, Milcent S, Desgrandchamps F, Mongiat-Artus P, Duclos JM, Teillac P, Urol Int 75(4):322–326, 2005). The versatility provided by the robot has allowed application of robot-assisted procedures in a variety of indications in managing urinary stone disease at different locations (Table 12.1). Herein we describe our technique of robotic pyelolithotomy and ureterolithotomy.
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