Pure robotic extended pyelolithotomy: cosmetic replica of open surgery

Abstract

Percutaneous nephrolithotomy (PCNL) has replaced open pyelolithotomy as the procedure of choice for treating large-burden renal stone disease, especially staghorn calculi. Although it is a minimally invasive procedure, it involves transgressing the renal parenchyma and is thus associated with its unique set of complications. The evolution of laparoscopic pyelolithotomy and robotic assistance has provided an opportunity to the surgeon to revisit pyelolithotomy in a minimally invasive manner following the age-old principles of the era of open renal surgery. We report the feasibility and our experience with this technique in three cases of partial staghorn calculus with intra-renal pelvis.

Keywords: Laparoscopy; Pyelolithotomy; Robotic; Staghorn calculus; Urolithiasis.

Fig. 1

Port position for right robotic pyelolithotomy after creation of the pneumoperitoneum

Fig. 2

Dissection of intra-renal pelvis. Renal pelvis (below) and renal parenchyma (above) are seen separated by the renal sinus fat (arrow)

Fig. 3

Infundibulotomy for inferior calyceal secondary calculus in right kidney

Fig. 4

Antegrade DJ stent placement (see text)

Fig. 5

Home-made plastic bag for retrieval of stones