Low Intraoperative Bleeding During Laparoscopic Nephrolithotomy: A Case Report

Abstract

: Renal stone disease is one of the most common conditions in urology. For renal stones larger than two centimeters, percutaneous nephrolithotomy (PCNL) is the primary treatment choice. Percutaneous nephrolithotomy provides the best stone-free rate compared to other modalities. However, PCNL can be challenging, especially in cases involving thick renal parenchyma, which may lead to internal organ bleeding. Additionally, PCNL requires highly advanced instruments, which may not always be available nationwide. Laparoscopic nephrolithotomy is a widely available surgical option that may offer similar benefits to PCNL. However, laparoscopic nephrolithotomy carries a higher risk of intraoperative bleeding compared to PCNL and open nephrolithotomy. A 45-year-old male presented to the emergency department with colic pain in the right flank persisting for over a year. Nephrolithiasis was diagnosed based on a KUB X-Ray and an abdominal CT scan. Laparoscopic nephrolithotomy with a small incision was performed, utilizing a hypotensive technique by anesthesia to reduce intraoperative bleeding. There were no perioperative complications, and 300 cc of blood loss was recorded intraoperatively. Laparoscopic nephrolithotomy proved to be a safe and effective treatment for renal stones in patients with thick renal parenchyma.