V03-07 INTRACORPOREAL ROBOTIC PYELOLITHOTOMY USING THE BOSTON SCIENTIFIC SWISS LITHOCLASTⓇ TRILOGY LITHOTRIPTER

Abstract

You have accessJournal of UrologyCME1 May 2022V03-07 INTRACORPOREAL ROBOTIC PYELOLITHOTOMY USING THE BOSTON SCIENTIFIC SWISS LITHOCLASTⓇ TRILOGY LITHOTRIPTER Micah Levy, Chih Peng Chin, Krishna T. Ravivarapu, Osama Al-Alao, and Michael Palese Micah LevyMicah Levy More articles by this author , Chih Peng ChinChih Peng Chin More articles by this author , Krishna T. RavivarapuKrishna T. Ravivarapu More articles by this author , Osama Al-AlaoOsama Al-Alao More articles by this author , and Michael PaleseMichael Palese More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002539.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The Boston Scientific Swiss LithoClast© Trilogy Lithotripter was released in 2019, intended for use in percutaneous nephrolithotomy (PCNL). Its use has been shown to improve efficiency for stone fragmentation and removal, however, it has never been used for intracorporeal procedures. Our video depicts the first use of the Trilogy lithotripter in intracorporeal robotic pyelolithotomy and discusses the indications and advantages of this technique. METHODS: The patient was a 65-year-old female with a large left staghorn calculus with hydronephrosis and a left ureteropelvic junction (UPJ) obstruction. The combination of a staghorn stone with a UPJ obstruction indicated the use of robotic pyelolithotomy for stone removal and UPJ reconstruction. Due to the size and location of the stone, it was decided to use the Trilogy lithotripter for more efficient stone removal. The patient was consented to undergo a robotic pyelolithotomy with Trilogy lithotripsy. RESULTS: The patient was positioned in the flank position. The robot was docked, and the abdomen was insufflated. Initial dissection was made, and the colon was mobilized, revealing a hydronephrotic kidney with significant inflammation and a large staghorn stone branching into the upper, middle, and lower pole. The 2.4mm Trilogy probe was passed into the abdomen through the 12mm assistant's port and under direct vision the stone was segmented into several large fragments which were manually removed by the robotic graspers. Renal endoscopy was performed using a disposable LithoVue™ ureteroscope and remnant stones were removed using a stone basket until the kidney and ureter were noted to be stone free. The operation was completed successfully with minimal estimated blood loss and no intraoperative or postoperative complications. The patient returned for a six-week follow-up, and CT scans showed full stone clearance with no signs of hydronephrosis. CONCLUSIONS: This was the first documented use of the Trilogy lithotripter during intracorporeal surgery. The Trilogy’s efficacy in intracorporeal surgery is partially due to its built-in cooling system which allows for use of the Trilogy with reduced need for continuous irrigation which must be limited during robotic pyelolithotomy. Thus, this technique was indicated for complex procedures such as robotic pyelolithotomy for stone removal and concurrent UPJ reconstruction. It proved to be an efficient method for staghorn stone fragmentation and removal without requiring multiple percutaneous incisions or multiple procedures. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e203 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Micah Levy More articles by this author Chih Peng Chin More articles by this author Krishna T. Ravivarapu More articles by this author Osama Al-Alao More articles by this author Michael Palese More articles by this author Expand All Advertisement PDF DownloadLoading ...