Laparoscopic Anatrophic Nephrolithotomy Research Articles

The role of robotic surgery in the management of renal tract calculi.

The role of robotic assisted surgery in contemporary urolithiasis management is in its infancy. The mainstay in the management of renal tract calculi remains ureterorenoscopy (URS), extracorporeal shock wave lithotripsy (ESWL) and percutaneous nephrolithotomy (PCNL). However, in rare clinical circumstances, such as large impacted pelvic and ureteric calculi, endo-urological techniques may not be adequate. Furthermore, patient may have a synchronous pathology such as pelvi-ureteric obstruction which preferably should be concurrently treated with the renal calculi in a single sitting. Robotic assisted laparoscopic ureterolithotomy (RALU), robotic assisted laparoscopic pyelolithotomy (RPL) with or without concurrent pyeloplasty and Robotic assisted laparoscopic anatrophic nephrolithotomy have all been described for complex stones. Additionally, technical challenges with a flexible ureteroscopy (FURS) have led to the development of robotic assisted flexible ureteroscopes. In the article we summarize the role of robotic assisted surgery in complex renal tract calculi.

Three-Dimensional Laparoscopic Anatrophic Nephrolithotomy

Abstract Introduction: The management of staghorn calculi and complete clearance remains technically challenging. Extracorporeal shockwave lithotripsy, percutaneous nephrolithotomy, or a combination therapy has limited efficacy. The stone-free status may require several sessions of these procedures and might result in considerable morbidity. We had done laparoscopic anatrophic nephrolithotomy for a large staghorn calculi with complete stone clearance in a single operative session with preserved renal function. In this video presentation, we show our technique of transperitoneal anatrophic nephrolithotomy for staghorn calculi. Materials and Methods: A 64-year-old male presented with right flank pain for 6 months duration and fever on and off for 4 months. CT urogram showed right staghorn calculus measuring 5.3 × 4.5 cm (HU up to 797) without hydronephrosis. The patient was taken for right anatrophic nephrolithotomy, right RGP and Double-J were placed before placing the patient in left lateral decubitus pos...

A preliminary study on laparoscopic anatrophic nephrolithotomy for renal staghorn stone

Objective To evaluate the feasibility and effectiveness of laparoscopic anatrophic nephrolithotomy (LAN) managing renal staghorn stone. Methods Forty patients whose age ranged from 17 to 73 years (median 46 years), who underwent LAN for renal staghorn stone were included in the retrospective study at Affiliated Hospital of Guizhou Medical University in the period between May 2011 and January 2015, including 24 males and 16 females. The body mass index ranged from18.4 to 27.3 kg/m2. The date of operative time, warm ischemia time, estimated blood loss, mean stone size, stone surface area, stone-free rate, rate of operative complications, postoperative hospital stay was collected. Functional imaging studies including GFR of operated kidney, serum creatinine (SCr), renal cortical thickness were obtained before the operation and compared to that of a follow-up of 6 months. Results A total of 40 patients were completed laparoscopically and none required conversion to open surgery. Operative time ranged from 87 to 142 min (median 102.5 min). The warm ischemia time ranged from 14 to 36 min (median 20.3 min). The estimated blood loss ranged from 20 to 120 ml (median 50 ml). The mean stone area (SA) ranged from 550 to 1583 mm3 (median 796 mm3). The largest diameter of the stones ranged from 34 to 72 mm (median 59 mm). The average postoperative hospital stay was (9.2±2.1) days, ranged from 6 to 12 days. The rate of operative complications was 17.5% (7/40), including 4 patients got urinary leak and 3 patients with bacteriaemia, no patients showed perioperation urosepsis, delayed renal hemorrhage, death and other severe complication. All patients cleared from their stones except 5 patients had small residual stones managed by extracorporeal shock wave lithotripsy 3 months later, of which three patients had a favorable effect and the last 2 patients got rid of small residual fragments automatically a few weeks later, the stone-free rate was 87.5% determined by KUB or CT on postoperative day 3. After a mean follow-up of 6 months, however, there was a significant mean decrease of (13.3±3.7) ml/min(P<0.05)in GFR of effected renal afterward and a significant mean decrease of 27.5μmol/L in SCr(P<0.05). Nevertheless, the atrophy of renal cortical was not obvious, the hydronephrosis was decreased compared to that of pre-treatment and with a significant improvement on renal function in all patients at follow-up IVU and CT. Conclusions The LAN is a feasible alternative for renal staghorn stone besides PCNL in minimal invasive methods for it has some advantages of high stone-free rate, less operative complications and less influence on renal function of affected kidney. Key words: Renal staghorn stone; Laparoscopic anatrophic nephrolithotomy; Operative complication

PE77: Robot-Assisted laparoscopic anatrophic nephrolithotomy with ice-slush for Staghorn stone

PE77: Robot-Assisted laparoscopic anatrophic nephrolithotomy with ice-slush for Staghorn stone

Laparoscopic Anatrophic Nephrolithotomy for Management of Staghorn Renal Calculi

Management of staghorn renal stones is still challenging. We present our experience with laparoscopic anatrophic nephrolithotomy as an alternative option for management of staghorn renal calculi. Twenty-four patients with staghorn renal calculi underwent 25 laparoscopic anatrophic nephrolithtomy procedures. Characteristics of patients and stones along with perioperative features such as operation time, transfusion, ischemic time, hospitalization, stone-free rate, and biochemical data were recorded prospectively. We applied the one-layer knotless technique for renorrhaphy repair. The mean age of the patients was 55.1 ± 10.9 years (range, 28-74 years). Eleven (44%) operations were done on the right side, and 14 (56%) were done on the left side. Complete and partial staghorn stones existed in 17 (68%) and 8 (32%) renal units, respectively. The mean stone size was 61.5 ± 11.5 mm. Ischemic time was 30.4 ± 7.55 minutes. The stone-free rate was 88% on discharge and 92% after one session of extracorporeal shockwave lithotripsy. Although percutaneous nephrolithotomy is the standard of care for treatment of staghorn stone, laparoscopic anatrophic nephrolithotomy seems to be a safe and feasible option in select patients.

Laparoscopic Anatrophic Nephrolithotomy for Management of Complete Staghorn Renal Stone: Clinical Efficacy and Intermediate-Term Functional Outcome

To report the clinical efficacy and intermediate-term functional outcome after laparoscopic anatrophic nephrolithotomy (LAN) as an alternative treatment modality for complete staghorn renal stone. The demographic and perioperative parameters as well as the intermediate outcome of 10 adults (9 men) who underwent transperitoneal LAN for complete staghorn renal stone were analyzed. Functional imaging studies consisted of intravenous urography (IVU) and technetium-99 dimercaptosuccinic acid scintigraphy (99Tc-DMSA) renal scan done before the operation and at the last follow-up visit. Mean age of patients was 48.7 years (range 37-64 years). Mean stone size was 67.3 mm (50-90 mm). Mean operative time was 192 minutes (110-240 min), and mean warm ischemia time was 32.8 minutes (15-40 min). A few hours after laparoscopy, one patient underwent splenectomy because of significant hemorrhage from a splenic laceration (grade IIIb complication). During the follow-up period early after the operation, we detected an 8-mm lower caliceal stone and a 25-mm midcaliceal stone in one patient each (stone-free rate: 80%). After a mean follow-up of 11.9 months (6-19 mos), 85.5% of corresponding renal unit function was preserved; however, there was a significant mean decrease in 99Tc-DMSA uptake from 48.4%±8.83 before surgery to 41.4%±13.98 afterward (-7%±6.53; P=0.008). Nevertheless, renal units were completely functional at follow-up IVU with a significant improvement in obstruction in all patients. LAN is an alternative minimally invasive approach for one-session management of patients with complete staghorn renal stone. It offers an acceptable rate of stone clearance and operative complications but does incur a minimal loss of function in the affected kidney.

Re: Laparoscopic Anatrophic Nephrolithotomy for Management of Complete Staghorn Renal Stone: Clinical Efficacy and Intermediate-Term Functional Outcome(From: Alireza Aminsharifi, Patris Hadian, and Kamran Bovei J Endourol 2013;27:000–000)

Re: Laparoscopic Anatrophic Nephrolithotomy for Management of Complete Staghorn Renal Stone: Clinical Efficacy and Intermediate-Term Functional Outcome(From: Alireza Aminsharifi, Patris Hadian, and Kamran Bovei J Endourol 2013;27:000–000)

V1715 LAPAROSCOPIC ANATROPHIC NEPHROLITHOTOMY FOR COMPLEX STAGHORN CALCULI WITH EARLY UNCLAMPING AND CONTROLLED HYPOTENSION - AN ATTEMPT TO PRESERVE RENAL FUNCTION

You have accessJournal of UrologyTransplantation, Urolithiasis & Hydronephrosis1 Apr 2012V1715 LAPAROSCOPIC ANATROPHIC NEPHROLITHOTOMY FOR COMPLEX STAGHORN CALCULI WITH EARLY UNCLAMPING AND CONTROLLED HYPOTENSION - AN ATTEMPT TO PRESERVE RENAL FUNCTION Rene Sotelo, Oswaldo Carmona, Robert De Andrade, Camilo Giedelman, Rafael Clavijo, Octavio almanzor, Roberto Garza, Roy Lopez, and Eduardo Banda Rene SoteloRene Sotelo Caracas, Venezuela More articles by this author , Oswaldo CarmonaOswaldo Carmona Caracas, Venezuela More articles by this author , Robert De AndradeRobert De Andrade Caracas, Venezuela More articles by this author , Camilo GiedelmanCamilo Giedelman Caracas, Venezuela More articles by this author , Rafael ClavijoRafael Clavijo Caracas, Venezuela More articles by this author , Octavio almanzorOctavio almanzor Caracas, Venezuela More articles by this author , Roberto GarzaRoberto Garza Caracas, Venezuela More articles by this author , Roy LopezRoy Lopez Caracas, Venezuela More articles by this author , and Eduardo BandaEduardo Banda Caracas, Venezuela More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.1674AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES There are clear indications for the treatment of complex staghorn stones by Anatrophic Nephrolithotomy. When a reasonable number of sittings are unlikely to clear the calculus, b. other endourologic interventions have failed, c. an associated structural anomaly needs correction or d. percutaneous access is technically unfeasible, anatrophic nephrolithotomy is the recommended procedure. Laparoscopy offers a minimally invasive option to these patients. METHODS Laparoscopic anatrophic nephrolithotomy was performed in 8 patients with complex staghorn calculi. Mean patient age was 49 years (35-62), mean stone size was 53 mm (35-70). The principles of open anatrophic nephrolithotomy are followed. The hilum is dissected; the artery and vein isolated and controlled with bulldog clamps. An incision is made with a laparoscopic knife in the avascular plane along Brodel′s line, approximately 1 cm from the lateral aspect of the kidney. The stone is extracted. The large vessels that are visualized are oversewn individually. Controlled Hypotension is applied minutes prior to hilum release. The clamps are removed within 20 minutes. Any additional bleeding vessels are oversewn. The blood pressure is gradually restored. As hemostasis is confirmed, the parenchyma is closed in a running fashion. RESULTS All patients were completed laparoscopically. Mean operative time was 142.5 min, mean warm ischemia time was 20.8 min. Average blood loss was 315 cc, mean average stay was 3.5 days. Complete clearance of the calculus was obtained in 5 patients. The 3 months post-operative scan showed an average reduction of 6.6%, which returned to normal in the long-term follow-up. CONCLUSIONS Our goal, besides removing the stone, is to preserve renal function. The technique has evolved achieving excellent hemostasis with an accurate incision along Brodel′s line and early unclamping along with controlled hypotension, to reduce ischemia time. Advantages of this technique are that it diminishes ischemia time, ensures hemostasis prior to kidney closure and decreases the risk for arteriovenous fistula or aneurysm formation. We hope this technique leads to preservation of renal function in patients with staghorn calculi. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e691-e692 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Rene Sotelo Caracas, Venezuela More articles by this author Oswaldo Carmona Caracas, Venezuela More articles by this author Robert De Andrade Caracas, Venezuela More articles by this author Camilo Giedelman Caracas, Venezuela More articles by this author Rafael Clavijo Caracas, Venezuela More articles by this author Octavio almanzor Caracas, Venezuela More articles by this author Roberto Garza Caracas, Venezuela More articles by this author Roy Lopez Caracas, Venezuela More articles by this author Eduardo Banda Caracas, Venezuela More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Laparoscopic Anatrophic Nephrolithotomy: Developments of the Technique in the Era of Minimally Invasive Surgery

The complete removal of the stone is the ultimate goal in management, a result that might not be attained even after several sessions of percutaneous nephrolithotomy (PCNL) and/or extracorporeal shockwave lithotripsy (SWL) and/or retrograde intrarenal surgery (ureteroscopy). The objective of this study is to assess our technique of anatrophic nephrolithotomy, with decreased renal ischemia and reduced patient morbidity. From 2007 to 2010, we performed eight anatrophic laparoscopic nephrolithotomies in adult patients with staghorn renal calculus. The mean patient age was 49 years (range 35-62 y). The mean stone size was 53 mm (range 35-70 mm). All patients had complex renal calculi, with stones occupying more than 80% of the caliceal system. In all cases, a Double-J stent was placed before surgery. After clamping the hilum, the incision was made laterally and longitudinally through full thickness of cortex using a laparoscopic scalpel. A running cortical suture was performed with Hem-o-lok reinforcement. Renal function was assessed in three patients, using renography with technetium-99m-diethylenetriaminepentacetic acid (99mTc-DTPA), before and 3 months after the surgery. Procedures for all patients were completed laparoscopically. The mean operative time was 142.5 minutes, and the mean warm ischemia time was 20.8 minutes. The estimated blood loss was 315 mL. The hospital stay average was 3.5 days. Only one patient had a complication--a vascular fistula with permanent postoperative hematuria. This patient subsequently underwent successful endovascular embolization. Residual stones were identified in 37% of cases (three patients) during follow-up imaging at 15 days. There were minimal changes on serum creatinine values. Laparoscopic surgery is feasible when anatrophic nephrolithotomy is indicated. This technique minimizes the barriers of an open flank incision, while achieving excellent stone-free rates. This minimally invasive technique should be considered for complex stones that would necessitate multiple renal access tracks and secondary procedures.

V50 Laparoscopic anatrophic nephrolithotomy with ice-slush for staghorn stone

V50 Laparoscopic anatrophic nephrolithotomy with ice-slush for staghorn stone

Retroperitoneal laparoscopic anatrophic nephrolithotomy for large staghorn calculi

Treatment of staghorn calculus is challenging. We evaluated the feasibility and efficacy of the retroperitoneal laparoscopic approach for the management of large staghorn renal calculi. Patients with staghorn renal calculi unsuitable for percutaneous nephrolithotomy were analyzed. They underwent retroperitoneal laparoscopic anatrophic nephrolithotomy, involving control of the renal artery, stone removal through a nephrotomy incision on the Brodel's line and closure with continuous sutures. A total of 11 patients with renal stones were included in the present study. Mean patient age was 55 years (range 42-68) and stone size was 52 mm (range 43-61). Warm ischemia time and operative duration were 31 (range 23-38) and 139 min (range 105-160), respectively. No blood transfusion was needed during or after operation. An 8-mm residual calculus remained in the lower calyces in one patient who was successfully treated by using shock wave lithotripsy. Intravenous pyelogram after surgery showed a functional corresponding renal unit, with an improvement in obstruction in all patients. Retroperitoneal laparoscopic technique can be applied for patients who are candidates for anatrophic nephrolithotomy. Larger studies with a longer follow up are needed to confirm these findings.

Bilateral laparoscopic anatrophic nephrolithotomy for managing staghorn renal calculi.

Figure 2. Sutures were buttressed by hemostatic clip instead of knots. Figure 1. Stone was removed from nephrotomy incision on Brodel line. INTRODUCTION In the current age of minimally invasive therapy, it is reasonable to offer open nephrolithotomy as the first line treatment for patients with complete staghorn renal calculi and/or infandibular stenosis. (1) The role of laparoscopic surgery as a minimally invasive method to manage staghorn renal calculi was formerly discussed only in limited articles.(2-4) In this case, we performed bilateral Laparoscopic anatrophic nephrolithotomy (LAN) for managing bilateral staghorn renal calculi in two separate sessions.

Laparoscopic anatrophic nephrolithotomy for managing large staghorn calculi

To evaluate the efficacy of a laparoscopic approach for managing large staghorn renal calculi. Laparoscopic transperitoneal anatrophic nephrolithotomy was used to duplicate open anatrophic nephrolithotomy in five patients (three men) with large staghorn renal stones unsuitable for percutaneous nephrolithotomy. Only the renal artery was clamped, using a bulldog clamp. The stone was removed through a nephrotomy incision on the Brodel line, which was closed using 3/0 polyglactin continuous sutures, and sutures were buttressed by haemostatic clips instead of knots. Intraoperative ultrasonography was used in the last two patients to evaluate residual stones. The mean (range) stone size was 53 (45-65) mm, the patient age was 53 (45-58) years, and the warm ischaemia and operative duration were 32 (29-35) and 170 (120-225) min, respectively. No blood transfusion was needed during or after surgery. All of the procedures were uneventful and there was no urine leakage after surgery. Only an 8-mm and a 6-mm residual stone remained in the first and third patients, in the lower and middle calyces, respectively. Both of them were subsequently treated with shock wave lithotripsy. An intravenous pyelogram after surgery showed a functional corresponding renal unit, with a significant improvement in obstruction in all patients. Laparoscopic anatrophic nephrolithotomy is a promising alternative for patients who are candidates for open surgery, with an acceptable stone-free rate. While offering a minimally invasive approach, it can minimize the need for secondary invasive interventions. Further patients and a longer follow-up are needed before this is suggested as the preferred method in selected patients in the future.

Laparoscopic anatrophic nephrolithotomy

Management of staghorn calculi is still a challenge. To combine the surgical principles of treatment with the minimal invasive access we performed a laparoscopic anatrophic nephrolithotomy in a female patient successfully. Patient was discharged free of stone on fifth postoperative day. No complications occurred.

Anatrophic Nephrotomy and Plastic Calyrhaphy

SummaryA technique of nephrotomy is described in which the kidney is not bivalved, rather the nephrotomy incision is placed between the junction of the anterior and posterior arterial segments. A new method utilizing vertical mattress sutures and water-tight closure is discussed. Correction of calyceal stenosis is achieved by calycoplasty. The results of this procedure in 138 patients as it has evolved in the last 12 years are reviewed.