Retroperitoneal laparoscopic anatrophic nephrolithotomy for large staghorn calculi

Abstract

Objectives: Treatment of staghorn calculus is challenging. We evaluated the feasibility and efficacy of the retroperitoneal laparoscopic approach for the management of large staghorn renal calculi.

Methods: Patients with staghorn renal calculi unsuitable for percutaneous nephrolithotomy were analyzed. They underwent retroperitoneal laparoscopic anatrophic nephrolithotomy, involving control of the renal artery, stone removal through a nephrotomy incision on the Brodel's line and closure with continuous sutures.

Results: A total of 11 patients with renal stones were included in the present study. Mean patient age was 55 years (range 42-68) and stone size was 52 mm (range 43-61). Warm ischemia time and operative duration were 31 (range 23-38) and 139 min (range 105-160), respectively. No blood transfusion was needed during or after operation. An 8-mm residual calculus remained in the lower calyces in one patient who was successfully treated by using shock wave lithotripsy. Intravenous pyelogram after surgery showed a functional corresponding renal unit, with an improvement in obstruction in all patients.

Conclusions: Retroperitoneal laparoscopic technique can be applied for patients who are candidates for anatrophic nephrolithotomy. Larger studies with a longer follow up are needed to confirm these findings.