PD13-11 A MULTICENTER EVALUATION OF ZERO-FRAGMENT NEPHROLITHOTOMY: ROBOTIC PYELOLITHOTOMY AND NEPHROLITHOTOMY FOR TREATING RENAL STONES

Abstract

You have accessJournal of UrologyStone Disease: Surgical Therapy I1 Apr 2015PD13-11 A MULTICENTER EVALUATION OF ZERO-FRAGMENT NEPHROLITHOTOMY: ROBOTIC PYELOLITHOTOMY AND NEPHROLITHOTOMY FOR TREATING RENAL STONES Ryan Swearingen, Rabii Madi, Zachary Klaassen, Ketan Badani, Akshay Sood, Jack Elder, Kyle Wood, Ashok Hemal, and Khurshid Ghani Ryan SwearingenRyan Swearingen More articles by this author , Rabii MadiRabii Madi More articles by this author , Zachary KlaassenZachary Klaassen More articles by this author , Ketan BadaniKetan Badani More articles by this author , Akshay SoodAkshay Sood More articles by this author , Jack ElderJack Elder More articles by this author , Kyle WoodKyle Wood More articles by this author , Ashok HemalAshok Hemal More articles by this author , and Khurshid GhaniKhurshid Ghani More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.1075AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Robotic pyelolithotomy and nephrolithotomy may be utilized for removing kidney stones as an alternate to percutaneous nephrolithotomy or flexible ureteroscopy. The purpose of this study is to present outcomes for these robotic procedures from a multi-center collaborative. METHODS We performed a retrospective review of cases performed at five academic centers. The procedures studied were robotic pyelolithotomy (RP) and robotic nephrolithotomy (RN), without a need for renal ischemia. RP was performed either transperitoneal or retroperitoneal approach. RN was performed using retroperitoneal approach. Patient characteristics and outcomes assessed include stone size (maximum diameter), stone volume (cm3), estimated blood loss (EBL), operative time, length of stay (LOS), stone-free rate (SFR) (zero-fragment rate), complications (Clavien grade), use of ureteral stent, and renal function. Patients on anti-coagulants were bridged on Lovenox. RESULTS 28 patients underwent 29 procedures (17 right-sided, 10 left sided, and 1 bilateral) for mean stone size and volume of 2.8 cm (range 1.0-5.8) and 21 cm3 (range 4.5-92.7), respectively. RP accounted for 26 of these procedures, RN for 2; one was a combined RP-RN. Indications included failed endourological management (8), failed ESWL (4), staghorn calculi (5), gas-containing infection (1), uretero-pelvic junction obstruction (2), calyceal diverticulum (1), previous/concomitant urinary tract reconstruction (2) and patient preference (6). Mean patient age was 37.9 years (range 1–77). Mean total operative and console times were 187 (range 101–300) and 138 minutes (range 48–245), respectively. Mean EBL was 56 ml (range 5–502). Two patients were on anti-coagulants and one patient was a Jehovah's Witness. Median LOS was 1.5 day (range 1–4). There was no significant change in pre- and post-operative serum creatinine. Two patients developed complications postoperatively (both Clavien grade 2); one patient had ileus whilst another had dislodged malecot catheter. Overall complication rate was 7%. Stents were placed in 18 patients. The SFR rate was 100%. CONCLUSIONS Robotic pyelolithotomy and nephrolithotomy are safe and reasonable options for removing large renal stones in select patients. Robotic pyelolithotomy allows removal of stones without transgressing the parenchyma which is a potential cause for bleeding and nephron loss. The robotic approach permits zero-fragment nephrolithomy where the stone is removed in toto thereby maximizing chances for complete stone clearance. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e266 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ryan Swearingen More articles by this author Rabii Madi More articles by this author Zachary Klaassen More articles by this author Ketan Badani More articles by this author Akshay Sood More articles by this author Jack Elder More articles by this author Kyle Wood More articles by this author Ashok Hemal More articles by this author Khurshid Ghani More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...