Introduction and Objectives: The pelvic kidney is the most common form of renal ectopia. An anomalous blood supply and a tortuous ureter with high insertion can lead to poor drainage of urine and formation of calculi. The management of stone disease in ectopic kidneys is very challenging. We report our technique of laparoscopic-assisted percutaneous nephrolithotomy (PCNL) in a 37-year old male patient, who was referred to our department with an ectopic malrotated right kidney containing a 17 × 15 mm sized calculus in the renal pelvis. The patient had previously undergone a flexible ureterorenoscopy during which the stone could not be reached due to difficult angulation. Methods: A computed tomography (CT) with three-dimensional (3D) reconstruction was performed preoperatively to identify the location of the stone and delineate the anatomy of the surrounding structures, including the blood vessels. Under general anesthesia, cystoscopy and pyelography were performed and a retrograde ureteric occlusion balloon was placed. The patient was then placed in the left lateral position and laparoscopy was performed. After mobilization of the large bowel, the kidney was identified and further exposed. The safe area in the lower pole was selected to puncture, taking into consideration the anatomy of renal vasculature. Contrast was used to opacify the renal system, and using fluoroscopy, a puncture needle was introduced to puncture the lower calix. A hydrophilic guide wire was initially inserted, and this was changed to an extra stiff guide wire over an access catheter. The guide wire was coiled in the upper calix. It was not possible to bring the wire into the ureter and bladder due to difficult anatomy. The tract was then dilated with the help of a balloon dilator and a 30F Amplatz sheath was placed. Once the guide wire was in place, we partially deflated the pneumoperitoneum and this helped us to use a normal-sized sheath and instruments for working. All the above steps were performed using fluoroscopic guidance under direct vision by laparoscopy. A nephroscope was used through the sheath. The stone was identified and fragmented using a handheld pneumatic lithotripter. All the fragments were removed using a tipless basket. At the end of the procedure, a Malecot nephrostomy tube was inserted through the tract over a guide wire. The ureteric balloon catheter was then removed with subsequent placement of a urethral catheter. After this, we again looked at the kidney for any bleeding and Surgicel® Fibrillar™ (Ethicon U.S., LLC, Somerville, NJ) was placed as a haemostatic agent. A percutaneous intraperitoneal drain was placed in the perinephric area and we did not try to retroperitonealize the kidney. The total operation time was 170 minutes. The blood loss was not significant. Results: The surgery was uneventful without any immediate perioperative complications. The urethral catheter was removed on the first postoperative day. A check plain X-ray of the abdomen (KUB) showed complete stone clearance. No nephrostogram was performed, and the nephrostomy tube was removed on the second day. The intraperitoneal drain was removed on the third day, and the patient was discharged from hospital on the fourth day. Conclusion: In our experience, laparoscopic-assisted PCNL is a safe and technically feasible procedure for the treatment of stone disease in ectopic kidneys. It is an attractive minimally invasive alternative to open pyelolithotomy. In experienced hands, it can achieve good stone clearance without any complications, especially in patients with a large stone burden or failed retrograde intrarenal surgery. However, the procedure should not be taken lightly due to the frequently associated anomalous anatomy and blood vessels. CT angiogram and 3D reconstruction is essential. Access and control of the renal vessels in the laparoscopic phase of the procedure is the key to effective and safe outcome. No competing financial interests exist. Runtime of video: 7 mins 38 secs