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: 2.89). 07/2006; 24(2):198-201. DOI: 10.1007/s00345-006-0099-6
Source: PubMed

ABSTRACT 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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    ABSTRACT: Purpose To evaluate surgical outcomes of laparoscopic pyelolithotomy (LP) in relation to stone distribution within the kidney. Methods Between August 2008 and February 2012, 77 patients underwent LP as first-line treatment for renal stone(s). Cases were classified into four groups, depending on stone location: Group I (located in only renal pelvis), Group II (located only in renal calyx), Group III (located in renal pelvis and in one calyx), and Group IV (located in renal pelvis and in multiple calyces). Patient and stone characteristics, surgical outcomes, and complications were evaluated. Results Sixty-seven (81.8%) of cases were stone-free after LP for large renal stones. Stone-free rates in a single session decreased significantly with greater stone dispersion (P < 0.001). Mean hospital stay in group IV was significantly longer than in other groups (P = 0.038). However, there were no significant differences in mean operation times (P = 0.214), mean change in serum hemoglobin (P = 0.709), postoperative analgesics usages (P = 0.153), and number of analgesics used on an as-needed basis (P = 0.079). There were no complications of grade IIIb or of greater severity. One patient in group II received blood transfusion, and 1 in group III required percutaneous drainage due to perirenal urine collection. Conclusions LP is an effective and safe modality for managing renal stones diseases. Distribution of stone burden, as well as total stone burden, is an important predictor of surgical outcome of LP in renal stone diseases.
    Journal of endourology / Endourological Society 12/2012; · 1.75 Impact Factor
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    ABSTRACT: To date, most cases of renal calculi have been managed with extracorporeal shockwave lithotripsy and endoscopic procedures. However, for complex renal stone conditions, these minimally invasive procedures may require multiple operative sessions. Open surgery is usually reserved as a salvage procedure, although it is invasive in nature. Laparoscopic treatment is well accepted in renal surgery. For stone disease, it can duplicate open surgical techniques such as pyelolithotomy, pyeloplasty, anatrophic nephrolithotomy, caliceal diverticulectomy and nephrectomy. Although the laparoscopic techniques for stone treatment are quite challenging, it is both feasible and safe. Laparoscopic treatment is a viable option for large renal stone treatment with an excellent stone-free rate, especially when patients require their stones to be treated within a single session. However, it is more invasive in nature than endourology procedures and so should be reserved as the last resort option for renal stone management in the modern endourology era.
    Therapeutic Advances in Urology 02/2011; 3(1):13-8.
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    ABSTRACT: Objectives To review the current role of laparoscopy and robot-assisted laparoscopy for managing urinary lithiasis.ResultsThe contemporary indications for laparoscopic stone management are: anatomical variations in location or shape of the kidney (pelvic kidney, horseshoe kidney and malrotated kidney); coexisting pathologies, e.g. pelvi-ureteric junction obstruction; and stones in a renal unit with lower ureteric obstruction. The laparoscopic approach allows the simultaneous management of both the pathologies. Symptomatic stones in diverticula not amenable to endourological intervention can be treated with laparoscopy. Large impacted pelvic and ureteric calculi with a functioning renal unit are an indication for laparoscopic ureterolithotomy or pyelolithotomy. This review of current reports suggests that in a selected group of patients with complex stone disease the laparoscopic approach offers good success rates with minimal complications. There are few reports of robotic procedures in stone disease but existing data suggest that it is feasible.Conclusion Laparoscopic surgery is effective for complex renal stones and offers excellent stone clearance rates with minimal morbidity. Laparoscopic surgery is complementary in managing these stones. Robot-assisted laparoscopic technique of urinary tract stone management is in its early stage of implementation and randomised trials that compare robot assisted outcomes with other minimally invasive techniques are needed.
    Arab Journal of Urology. 03/2012; 10(1):32–39.