Laparoscopic Transperitoneal Pyelolithotomy for Management of Staghorn Renal Calculi

Abstract

Recent developments in laparoscopic and retroperitoneoscopic techniques have modified the treatment of renal and ureteral stones. We present the efficacy and possible adverse complications of laparoscopic pyelolithotomy for the treatment of staghorn stones as an alternative to percutaneous nephrolithotomy (PCNL) in our single-surgeon series. Thirteen patients (10 males and 3 females) underwent transperitoneal laparoscopic pyelolithotomy for removal of staghorn stones. Mean stone size was 5.1 cm (range, 4-6.5 cm). All patients had large stones in the renal pelvis and several (more than two) calices with extrarenal pelvis. Mean operative time was 177 minutes (range, 110-240 minutes), and the mean hospital stay was 4 days (range, 3-7 days). Transfusion was not required in any patient, and open conversion did not happen. Overall success rate was 84.6% (11/13), and 2 patients had residual stones that were managed with extracorporeal shockwave lithotripsy. There were no major complications (bleeding, sepsis, bowel injury, or urinary leakage). The role of laparoscopic kidney stone surgery has not been defined well, but laparoscopic transperitoneal pyelolithotomy may be performed with proper results and negligible complications in skillful hands. It could be a suitable alternative to PCNL for the treatment of staghorn stones in selected cases.