Robotic extended pyelolithotomy for treatment of renal calculi: A feasibility study
Hospital Kuala Lumpur, Kuala Lumpor, Kuala Lumpur, MalaysiaWorld Journal of Urology (Impact Factor: 2.67). 07/2006; 24(2):198-201. DOI: 10.1007/s00345-006-0099-6
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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- "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.  One patient required conversion to an open procedure because the renal calculus could not be localised. "
ABSTRACT: Robotic surgery is a cutting edge and minimally invasive procedure, which has generated a great deal of excitement in the urologic community. While there has been much advancement in this emerging technology, it is safe to say that robotic urologic surgery holds tremendous potential for progress in the near future. Hence, it is paramount that urologists stay up-to-date regarding new developments in the realm of robotics with respect to novel applications, limitations and opportunities for incorporation into their practice. Robot-assisted surgery provides an enhanced 3D view, increased magnification of the surgical field, better manual dexterity, relatively bloodless field, elimination of surgeon′s tremor, reduction in a surgeon′s fatigue and mitigation of scattered light. All these factors translate into greater precision of surgical dissection, which is imperative in providing better intraoperative and postoperative outcomes. Pioneering work assessing the feasibility of robotic surgery in urology began in the early 2000′s with robot-assisted radical prostatectomy and has since expanded to procedures such as robot-assisted radical cystectomy, robot-assisted partial nephrectomy, robot-assisted nephroureterectomy and robot-assisted pyeloplasty. A MEDLINE search was used to identify recent articles (within the last two years) and publications of specific importance, which highlighted the recent developments and future direction of robotics. This review will use the aforementioned urologic surgeries as vehicles to evaluate the current status and future role of robotics in the advancement of the field of urology.
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- "Several studies have demonstrated the efficacy and safety of LP for large renal stones . The stone - free rates ranged between 88 . 9% and 100% [ Salvado et al . 2009 ; Badani et al . 2006 ; Nambirajan et al . 2005 ] ."
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.
Article: Robotic Surgery for Urolithiasis[Show abstract] [Hide abstract]
ABSTRACT: Minimal invasive surgery has made a major impact in the management of urolithiasis. This has been possible due to miniaturization of scopes and improvements in equipment, energy sources and imaging. Despite these advances, open stone surgery is the optimal choice in a number of situations. In most such situations, laparoscopy allows a minimally invasive option and, now, robotic assistance to laparoscopy has made this easier and efficacious. This is particulalrly true for situations requiring reconstruction. In this chapter, we review the current indications, techniques, pitfalls and their solutions for robotic surgery for urolithiasis.