Laparoscopic Pyelolithotomy Research Articles

The comparison of laparoscopic pyelolithotomy and percutaneous nephrolithotomy in the treatment of solitary large renal pelvic stones

The aim of the study is to investigate whether laparoscopic pyelolithotomy (LPL) could find a place in the management of large renal pelvic stones which are generally considered as excellent indications for percutaneous nephrolithotomy (PNL). Between 2006 and 2009, 26 consecutive patients with large (>4 cm(2)) renal pelvic stones were treated by LPL and their charts were compared to 26 match-paired patients treated with PNL during the same period. The patients were matched for age, BMI, stone size and location as well as presence of congenital anomalies. Perioperative and postoperative findings were compared. The mean age, mean stone size, rate of congenital anomalies, history open renal surgery and shock wave lithotripsy were similar in both groups (p > 0.05). The mean operation time was 138.40 ± 51.19 (range 70-240) min in LPL group as compared to 57.92 ± 21.12 (range 40-110) min in PNL group (p < 0.0001). There was one (3.8%) open conversion in the LPL group due to dense perirenal adhesions making the dissection difficult. The ureteropelvic junction (UPJ) obstruction concomitant to pelvic stones was successfully repaired laparoscopically in two cases. The mean drop in postoperative hemoglobin level was 0.9 ± 0.6 (range 0-2) g/dl in LPL group and 1.7 ± 1.1 (range 0-4) g/dl in PNL group (p = 0.024). Hospitalization was significantly shorter in PNL than LPL group (p = 0.0001). Stone-free rates were similar. Laparoscopic pyelolithotomy is associated with a longer operation time, is more invasive, and requires more skills when compared to PNL. However, LPL is associated with less blood loss. Laparoscopic pyelolithotomy is indicated for congenitally anomalous kidneys and especially in patients with concomitant UPJ.

Retroperitoneal Laparoscopic Pyelolithotomy in an Ectopic Pelvic Kidney

Retroperitoneal laparoscopic pyelolithotomy was performed in an ectopic pelvic kidney with renal pelvis calculi. Laparoscopic pyelolithotomy was successfully performed in an ectopic pelvic kidney by using the retroperitoneal route. The total operation time was 130 minutes, and the estimated blood loss was < 50 mL. The patient was discharged on the second postoperative day without any complications. Laparoscopic pyelolithotomy is an effective treatment option for management of stones in the pelvis of an ectopic pelvic kidney. The retroperitoneal route may help to avoid intraoperative and postoperative complications.

Laparoscopic Transperitoneal Pyelolithotomy for Management of Staghorn Renal Calculi

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.

Laparoscopic transperitoneal pyelolithotomy as an alternative to percutaneous nephrolithotomy for stones in anomalous kidneys: a preliminary report

Objective: We report our experience with laparoscopic transperitoneal pyelolithotomy (LTPL) and percutaneous nephrolithotomy (PCNL) in the management of patients with calculi in anomalous kidneys. Materials and methods: Data from 11 patients who underwent LTPL and 13 patients who underwent PCNL for kidney stones between May 2006 and August 2010 were retrospectively analyzed. A flexible nephroscope and holmium:YAG laser lithotripsy were used for stone clearance in 2 patients in LTPL group and 3 patients in PCNL group. Results: The two groups were similar in age, body mass index, and sex; however, mean stone size was slightly greater in the PCNL group, although this difference was statistically insignificant. Mean operative time and hospitalization time were significantly higher in the LTPL group whereas estimated blood loss and mean postoperative analgesic requirement were significantly reduced in the LTPL group. There were no statistically significant differences in terms of stone size, complication rates, blood transfusion rates or stone-free status. There were no residual fragments in either group, and complete clearance was achieved in all the cases. Conclusion: With an experienced surgical team, most cases of stone disease in congenitally abnormal kidneys can be treated laparoscopically with low postoperative morbidity and complication rates, a short convalescence time, and good functional results.

VID-06.03 Nephroscopy with Carbon Dioxide in Combination with Laparoscopy in the Treatment of Urinary Stones

Most urinary tract stones can be treated effectively with no invasive or endourological procedures. Nevertheless, in selected patients with complex stones or anatomical abnormalities, a laparoscopic approach in combination with endoscopic procedures could be performed. In these cases, the use of irrigation fluid during the nephroscopy may be a pitfall because, in an opened renal pelvis, large amounts of fluid are collected in the peritoneal cavity. The use of carbon dioxide (CO2) to insufflate the collecting system may to facilitate nephroscopy during laparoscopic pyelolithotomy.

Combined Laparoscopic Transpyelic Ballistic Lithotripsy and Renal Cyst Ablation

Abstract Introduction: Laparoscopic pyelolithotomy could be challenging in case of pyelocaliceal staghorn stones trapped by a narrow caliceal neck. The video describes a laparoscopic concomitant re...

Laparoscopic Pyelolithotomy in Selected Patients with Ectopic Pelvic Kidney: A Feasible Minimally Invasive Treatment Option

Ectopic pelvic kidney is a rare congenital anomaly. It carries more risks for obstruction and stone formation than a normal located kidney. The treatment of renal stones in these patients is challenging. We present our experience with laparoscopic pyelolithotomy for treatment of selected patients with large and multiple renal stones in ectopic pelvic kidneys. After insertion of a ureteral catheter, pneumoperitoneum was achieved by Veress needle, and the kidney was exposed. The renal pelvis was identified, dissected, and opened. The stones were extracted using laparoscopic forceps. The rigid nephroscope was used to extract any caliceal stones. The renal pelvis was sutured, and the stones were removed from the peritoneal cavity. The procedure was concluded after placement of an intraperitoneal drain. A total of 11 patients with large renal pelvic and/or multiple stones underwent laparoscopic transperitoneal pyelolithotomy. A transmesenteric approach was used in eight patients while the colon was mobilized off the kidney in three patients. All stones were removed except one that needed Double-J stent placement and one session of shockwave lithotripsy. After one auxiliary procedure, the stone-free rate was 100%. There were no major intraopertive or postoperative complications. Within a mean follow-up period of 23 months, no stone recurrence occurred. Laparoscopic pyelolithotomy for large and multiple stones in ectopic pelvic kidneys is a feasible minimally invasive treatment option. The technique allows removal of all the stones without fragmentation, which may decrease the possibility for rapid stone recurrence.

V1559 LAPAROSCOPIC ROBOT-ASSISTED PYELOLITHOTOMY IN EMPHYSEMATOUS PYELONEPHRITIS

INTRODUCTION AND OBJECTIVES: Emphysematous pyelonephritis is an acute severe necrotizing infection of the renal parenchyma and its surrounding tissues that results in the presence of gas in the renal parenchyma. The pathogenesis is poorly understood. The cause for mortality in emphysematous pyelonephritis is primarily due to septic complications. Up to 95% of the cases with emphysematous pyelonephritis have underlying uncontrolled diabetes mellitus. A 59 year old female patient presented in our clinic with symptoms of a right pyelonephritis and a history of recurring pyelonephritis and severe sepsis. The computer tomography showed an emphysematic pyelonephritis with an amorphous stone in the right renal pelvis and multiple calculi in the calyces. An exigent ureteral stent was inserted. Proteus mirabilis was demonstrated in the urine culture. Because of the persistent infection with gas formation we decided upon a laparoscopic, robot-assisted pyelolithotomy. This video demonstrates the technique of transperitoneal laparoscopic robot-assisted pyelolithotomy in emphysematous pyelonephritis. METHODS: A transperitoneal access was established and four working trocars and a camera trocar were inserted. After mobilisation of the descending colon, the right colonic flexure und the duodenum as well as identification of the vena cava, the right ureter was identified and the kidney surface denuded. Following its identification the uretero-pyelon junction is incised longitudinally. Now white necrotic masses are to be seen. These are removed piece for piece with the bipolar forceps until, with rinsing and suction the renal pelvis is completely cleared. The existing ureteral stent is removed via the pelvic incision and a new French 7 stent is inserted antegrade into the ureter. The renal pelvis is closed with 3-0 continuous sutures and the corpus adiposum of the renal sinus is re-adapted. A French 6 wound drain is positioned. RESULTS: No results to this instructional video. CONCLUSIONS: The histology shows partially calcified amorphous material imbebbed with coccoand rod-bacteria. The operation was uneventful and the patient could be released on post-op day 8. Four weeks after the procedure the patient was complicationand infection-free so that the ureteral stent could be removed. The laparoscopic, robot-assisted pyelolithotomy is an effective and minimal invasive therapy option for emphysematous pyelonephritis.

Transperitoneal laparoscopic pyeloplasty: Brazilian initial experience with 55 cases

To evaluate prospectively the results obtained in 55 patients undergoing laparoscopic pyeloplasty through transperitoneal access. From January 2005 to July 2009, fifty-five patients between 13 and 64 years old, were treated for ureteropelvic junction (UPJ) stenosis via a transperitoneal laparoscopy. All patients had clinical symptoms of high urinary obstruction and hydronephrosis confirmed by imaging methods. Anderson-Hynes dismembered pyeloplasty was performed in 51 patients and Fenger technique in the other 4 cases. Patients were clinically and imaging evaluated in the postoperative period at 3 and 6 months and then followed-up annually. The operative time ranged from 95 to 270 min. The mean hospital stay was 2 days. The average blood loss was 170 mL. The time to return to normal activities ranged from 10 to 28 days. Anomalous vessels were identified in 27 patients, intrinsic stenosis in 23 patients and 5 patients had high implantation of the ureter. Laparoscopic pyelolithotomy was successfully performed in 6 patients with associated renal stones. That series monitoring ranged from 1 to 55 months. One patient had longer urinary fistula (11 days), 3 patients had portal infection and 6 patients had prolonged ileus. There was one conversion due to technical difficulties. From the later postoperative complications, 2 patients had re-stenosis, one determined by Anderson-Hynes technique and the other by Fenger technique. The success rate was 95.65%. Laparoscopic pyeloplasty has functional results comparable to conventional open technique. It offers less morbidity, with aesthetic and post-operative convalescence benefits and lower complication rates.

Carbon Dioxide-Based Nephroscopy During Laparoscopic Pyeloplasty Provides Suboptimal View When Stones Are Located in the Lower Calices

Flexible nephroscopy while using carbon dioxide to insufflate the collecting system has been described as a "good trick" to remove caliceal stones during laparoscopic pyelolithotomy. We found this true only for those calices with undisturbed urine drain into the renal pelvis, while it provided suboptimal view of stones that were located in dependent lower pole calices. We describe how we dealt successfully with a group of lower pole caliceal stones during laparoscopic pyeloplasty.

Laparoscopic Pyelolithotomy for Partial Staghorn Stones

Objective: To confirm the feasibility and safety of laparoscopic pyelolithotomy in partial staghorn stones. Patients and Methods: Seventeen patients who underwent laparoscopic pyelolithotomy for partial staghorn stone were included in the prospective study at King Abdulaziz University Hospital in the period between May 2007 and Feb 2009. Preoperatively all patients had blood work, urine culture, ultrasonography and CT renal stone study. Inclusion criteria included stones with largest diameter of more than 25 mm (measured by CT), branching into one or more group of calices, and no contraindication for laparoscopic surgery. All patients underwent cystoscopy, double J stent insertion prior to the procedure, while prophylactic antibiotics were provided for all the patients with or without positive urine culture. Results: All patients were completed laparoscopically where none required conversion to open surgery or developed intraoperative complications. The largest diameter of the stones varied between 29 and 48 mm with mean diameter of 41 mm, and the number of stones removed was 1–4 with mean of 1.3. The mean operative time was 175 minutes (range 125–240 minutes) and the estimated blood loss was 20–150 ml with mean of 49 ml. All patients cleared from their stones except 2 patients had small residual stones of 5 and 7 mm which were managed later by extracorporeal shock wave lithotripsy. One patient developed ileus postoperatively. Conclusion: Laparoscopic removal of partial staghorn stones is safe and feasible and has an equal outcome to open surgery.

Laparoscopic urinary stone surgery: an updated evidence-based review

The treatment of urinary lithiasis has been revolutionized during the last three decades. Minimally invasive therapies in the form of endoscopic surgery in companion with the advent of shock wave lithotripsy have diminished the role of open stone surgery. Laparoscopy, another minimally invasive treatment, is continuously gaining place in the treatment of urinary stones, mainly replacing open surgery. We have tried to identify the level of the evidence and grade of recommendation, according to the evidence-based medicine criteria, in studies supporting the laparoscopic approach to stone extraction. The highest level of evidence (IIa) was found for laparoscopic ureterolithotomy. It is technically feasible with the advantage of being minimally invasive and having lower postoperative morbidity compared to open ureterolithotomy. It is mostly recommended (grade B) for large impacted stones or when endoscopic ureterolithotripsy or shock wave stone disintegration have failed. Laparoscopic pyelolithotomy is feasible but rarely indicated in the present era (III/B). Laparoscopic nephrolithotomy may be indicated to remove a stone from an anterior diverticulum or when PNL or flexible ureteroscopy have failed (III/B).

The Combination of Laparoscopy and Nephroscopy for Treatment of Stones in Pelvic Ectopic Kidneys

Introduction: Minimally invasive treatment modalities for patients with large stone burden within pelvic kidneys present a special challenge. Interposing bowel loops between the kidney and the anterior abdominal wall, abnormalities in the vascular supply, and mal-rotation of the caliceal system are reasons of difficulties in percutaneous nephrolithotomy (PNL). Minimally invasive treatment modalities of large stones in ectopic pelvic kidneys have included pure laparoscopic pyelolithotomy,1–3 laparoscopy-assisted PNL,4–7 and ultrasound-guided PNL.8 These are attractive treatment options because they have the advantages of reduced analgesic requirement, shorter hospital stay, early convalescence, and better cosmoses in addition to high safety and efficacy profiles. The combination of laparoscopic and percutaneous approaches allows the establishment of the percutaneous tract into the kidney under direct vision, thus avoiding the risk of injury to abdominal viscera and blood vessels. This video presents the technique of the combination of laparoscopy and nephroscopy for treatment of stones in pelvic ectopic kidneys. Patients and Methods: The study included seven men and four women (mean age, 43 ± 9 years). Laparoscopy-assisted PNL was performed for caliceal stones in five patients after failure of shockwave lithotripsy. Laparoscopic pyelolithotomy was performed for six patients with large or branched renal pelvic stones. The patient was placed in the Trendelenburg position with slight lateral elevation of the side to be operated. In laparoscopy-assisted PNL the primary surgeon stands on the same side of the affected kidney and the assistant on the opposite side, whereas in laparoscopic pyelolithotomy the surgeon stands on the opposite side of the affected kidney. Three or four transperitoneal ports were placed in a fan-shaped distribution. The stone or the renal pelvis was identified using intraoperative fluoroscopy. Intermittent fluoroscopy was used to identify the point of entry to the desired calix during dilatation and during fixation of the nephrostomy tube. Results: The average preoperative stone length was 3 ± 1 cm (range, 1.1–4.2). There were some adhesions between the intestinal loops and the peritoneum on the anterior surface of the kidney in three patients (27%). There were neither intraoperative nor postoperative complications, and conversion to open surgery was not required. The mean hospital stay was 3.5 ± 0.7 days (range, 2–4). The stone-free rate was 91% as all stones were removed completely in 10 patients, whereas 1 patient had residual caliceal fragment that was treated with shockwave lithotripsy. After a mean follow-up of 27 ± 6 months, two out of the five patients who underwent laparoscopy-assisted PNL showed stone recurrence and were treated with extracorporeal shockwave lithotripsy. Conclusion: The combination of laparoscopy and nephroscopy for treatment of stones in pelvic kidneys is feasible, safe, and effective. The authors has nothing to disclose. Runtime of video: 8 min 24 sec

Retroperitoneal laparoscopic pyelolithotomy versus extra corporeal shock-wave lithotripsy for management of renal stones

AIM:The purpose of this study was to evaluate the role of retroperitoneal laparoscopic pyelolithotomy (RPPL) and its comparison with extra corporeal shock wave lithotripsy in the management of renal calculi.MATERIALS AND METHODS:The study was carried out in the Department of surgery, Maulana Azad Medical College, New Delhi, India. The study included 86 cases of solitary renal calculi in the retroperitoneoscopic (RPPL) group and 82 cases in the shock wave lithotripsy (SWL) group. The parameters compared were stone clearance, hospital stay, number of postoperative visits, mean time to resume normal activities, number of man days lost, and analgesic requirement.RESULTS:The RPPL group showed better stone clearance, fewer hospital visits, low analgesic requirement, fewer number of man days lost, and early resumption of normal activities, as compared to the SWL group.CONCLUSIONS:Shock wave lithotripsy, being a noninvasive modality, is an established procedure all over the world. However RPPL achieves comparable or better results in high volume centers.

Evaluation of the role of preoperative Double-J ureteral stenting in retroperitoneal laparoscopic pyelolithotomy

Since the first retroperitoneal laparoscopic pyelolithotomy (RPPL) was reported by Gaur and associates in 1994, its technique has improved considerably. The applicability and indications of the procedure are expanding with advances in technology, expertise, and experience. To date, there has been no prospective study in the literature about the role of preoperative Double-J (D-J) ureteral stenting in patients who undergo RPPL. This study is an endeavor to evaluate the role of preoperative D-J stenting in RPPL. The study included 184 patients, who were randomized into 2 groups. Group A included 95 patients, who underwent RPPL with D-J stenting. Group B included 89 patients, who underwent RPPL without D-J stenting. In group A, D-J stents were inserted under local anesthesia preoperatively, on the side of surgery. Complications during surgery and during the postoperative period were carefully recorded. The duration of drainage and volume in group A was significantly lower than in group B. The duration of postoperative stay was significantly reduced in group A (mean 3.3 vs. 5.74 days). The analgesic requirement in group A also was significantly lower than in group B (mean 378.95 vs. 558.99 mg). No statistically significant difference existed between the two groups, in terms of minor intraoperative and postoperative complications (25.3% vs. 29.2%; p < or = 0.547). D-J stenting and type of renal pelvis influenced the results, i.e., duration of drainage, analgesic requirement, and duration of stay, in patients undergoing RPPL. However, there was no significant difference in operative time, intraoperative blood loss, and postoperative complications. D-J stent group had significant increase in the rate of urinary tract infection postoperatively.

Laparoscopic Pyelolithotomy: Optimizing Surgical Technique

The classic approach to renal stone disease includes shockwave lithotripsy, ureteroscopy or percutaneous nephrolithotripsy, and, in some cases, a combination of both. The usefulness of laparoscopy in this regard remains debated. In this report and video, we present our technique of laparoscopic pyelolithotomy assisted by flexible instrumentation to achieve maximal stone clearance in a selected group of patients.

LAPAROSCOPIC PYELOLITHOTOMY: OPTIMIZING SURGICAL TECHNIQUE

You have accessJournal of Urology1 Apr 2009LAPAROSCOPIC PYELOLITHOTOMY: OPTIMIZING SURGICAL TECHNIQUE José A. Salvadó, Sergio Guzmán, and Cristian Trucco José A. SalvadóJosé A. Salvadó More articles by this author , Sergio GuzmánSergio Guzmán More articles by this author , and Cristian TruccoCristian Trucco More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(09)62054-1AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "LAPAROSCOPIC PYELOLITHOTOMY: OPTIMIZING SURGICAL TECHNIQUE." The Journal of Urology, 181(4S), p. 736 © 2009 by American Urological AssociationFiguresReferencesRelatedDetails Volume 181Issue 4SApril 2009Page: 736 Advertisement Copyright & Permissions© 2009 by American Urological AssociationMetricsAuthor Information José A. Salvadó More articles by this author Sergio Guzmán More articles by this author Cristian Trucco More articles by this author Expand All Advertisement PDF downloadLoading ...

UROLOGIST VERSUS RADIOLOGIST-MADE PCNL TRACTS; THE UK EXPERIENCE

To assess the feasibility of laparoscopy in the treatment of pediatric urolithiasis, we report our experience with the transperitoneal laparoscopic removal of stones.Renal pelvic stones of size ≥1 cm on ultrasound were included for laparoscopic pyelolithotomy while smaller stones were managed with shock-wave lithotripsy monotherapy. Intrarenal stones, calyceal stones, complete staghorn stones, multiple stones and kidneys with intrarenal pelvis were excluded. Ureteric stones included for laparoscopic ureterolithotomy were of size ≥1 cm in the upper, mid or lower ureter, and smaller stones not responding to non-operative treatment.A total of 22 procedures were performed: 12 pyelolithotomies, and 8 lower and 2 upper ureterolithotomies. Complete removal of calculi was accomplished in 21 (95.45%) procedures. Complications associated with laparoscopic lithotomy included urinoma (4.54%), failure (4.54%) and omental prolapse (4.54%).Laparoscopic lithotomy is safe and feasible in pediatric urolithiasis with pyelic and ureteric stones, with minimal complications and failure rate.

Laparoscopic pyelolithotomy: Is the retroperitoneal route a better approach?

To compare the outcome of laparoscopic pyelolithotomy (LP) using the transperitoneal and the retroperitoneal routes. Demographics, intraoperative and postoperative clinical parameters were evaluated in 48 laparoscopic pyelolithotomies performed in patients with renal pelvic calculi of diameter >30 mm. The differences between the transperitoneal and retroperitoneal routes were analyzed. Twenty-seven LP were performed using the transperitoneal approach (TLP), and 21 using the retroperitoneal approach (RLP). Apart from weight, the patients' demographics and stone size were similar in the two groups. Between the RLP and the TLP routes, the operative time was 112.1 versus 93.2 min (P = 0.01), mean time for oral intake was 1.9 versus 1.2 days (P < 0.01), and mean hospital stay was 5.2 versus 3.8 days (P < 0.01). The mean postoperative analgesic requirement (2.4 vs 2.2 days, P = 0.41), mean convalescence days (9.7 vs 10 days, P = 0.56), and mean estimated blood loss (57.2 vs 62.9 ml, P = 0.5) were similar between RPL and TPL respectively. The stone-free rate at 3 months follow-up was comparable (88.9% vs 90.5%, P = 0.86). The postoperative complications were not significantly different. Compared with the TLP approach, RLP for large renal pelvic stone resulted in a shorter operative time, a shorter resumption time for normal oral intake, and a shorter hospital stay. As the other clinical outcomes are similar, including the stone-free rate, we recommend the RLP route for LP.

Carbon Dioxide Based Nephroscopy: A Trick for Laparoscopic Pyelolithotomy

For certain selected cases, laparoscopic pyelolithotomy is a practical and effective method to manage renal stone disease. One such case is that of an ectopically located pelvic kidney with a large stone burden. Here, we describe our technique and provide what we feel is a trick to performing a key part of this procedure--flexible nephroscopy while using carbon dioxide gas to "inflate" the collecting system.