Robotic Pyelolithotomy Research Articles

Robotic pyelolithotomy for the treatment of large renal stones: a single-center experience over seven years.

Urolithiasis prevalence varies globally between 1-20%, influenced by regional factors. Robotic pyelolithotomy (RPL) presents an interesting alternative to PCNL, considered the gold standard for symptomatic stones smaller than 20 mm, as it carries a risk of significant complications. However, studies on RPL are limited, especially in anatomically complex cases, where RPL proves to be particularly useful. The study aims to update and review outcomes of RPL in a high-volume robotic center. A retrospective analysis of 153 patients treated with RPL for staghorn kidney stones at a single center from February 2016 to December 2023 was conducted. Data including demographics, preoperative renal function, stone characteristics, operative and postoperative outcomes, and costs were collected. Stone-free rates (SFR) and complications were assessed at follow-up intervals up to 12 months post-surgery. The study showed an initial 3-month stone-free rate (SFR) of 93.5%, which decreased to 83.5% at 12-months. This trend may reflect new stone formation rather than procedure failure. Sub-analysis revealed a significant difference in SFR between patients with pelvic and pyelocalyceal stones at each follow-up. Multivariate regression analysis identified in the pyelocalyceal group that higher BMI and larger stones were associated with higher failure rates at both 6 and 12 months. RPL is a safe and effective treatment for large renal stones, offering a high SFR and low complication rate. It is particularly beneficial in cases with complex anatomy or requiring concurrent renal procedures. However, patient selection is crucial, considering factors like stone location and size. Further research is needed to compare RPL with other treatment methods.

VE23 Using a 12 mm trocar as an access sheet during robotic pyelolithotomy

VE23 Using a 12 mm trocar as an access sheet during robotic pyelolithotomy

Case report: Crossed fused renal ectopia with stones: Asurgical challenge overcome by robotic surgery.

Crossed fused renal ectopia (CFRE) is an extremely rare congenital anomaly of the urinary tract that is prone to stone formation. The surgical treatment of CFRE with stones is challenging due to anatomical abnormalities. Right kidney stones were treated by flexible ureteroscopic lithotripsy (FURSL) and left kidney stones were treated by robotic surgery. The authors present an unreported case of bilateral renal stones in a patient with CFRE, which was successfully treated by robotic pyelolithotomy combined with FURSL. The procedure was manoeuverable, and the stone-free rate was satisfactory. CFRE with stones (S-shaped kidney) present a surgical challenge due to anatomical abnormalities and a high stone burden. The authors recommend robotic pyelolithotomy with or without FURSL as a viable treatment option for stones with similar anatomical abnormalities.

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

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 ...

Robotic pyelolithotomy in a solitary pelvic kidney complicated with fulminant Clostridium difficile: a case report

BackgroundRobotic-assisted surgeries have gradually become the standard of care for many procedures, especially in the field of urology. Despite the widespread use of robotic assistance in surgeries, data on its postoperative complications are extremely limited. We detail a rare presentation of fulminant Clostridium difficile colitis requiring surgical intervention in a patient with a solitary ectopic pelvic kidney who underwent a robotic-assisted pyelolithotomy. Highlights of the most recent management recommendations for C. difficile infection are also presented.Case presentationA 26-year-old Caucasian woman who underwent a robot-assisted pyelolithotomy of a pelvic kidney developed tachycardia, leukocytosis, and severe diarrhea 2 days following surgery. Because of her long history of antibiotic use, her severe symptoms were concerning for C. difficile colitis. This was confirmed by a C. difficile toxin test and a computed tomography scan. She was given recommended antibiotics, but her condition progressively deteriorated. The patient developed fulminant colitis and toxic megacolon, for which she underwent an exploratory laparotomy with subtotal abdominal colectomy and ileostomy creation on the twelfth day of her hospitalization. She fully recovered and was discharged 3 weeks after her subtotal colectomy.ConclusionAlthough robotic surgeries have been shown to have several advantages, risk of postsurgical complications remains. We present a rare case of fulminant C. difficile colitis that complicated a robotic-assisted pyelolithotomy. Active prevention, early detection, and optimization of management are essential to preventing unfavorable outcomes.

The fight between PCNL, laparoscopic and robotic pyelolithotomy: do we have a winner? A systematic review and meta-analysis.

The aim of this systematic review and meta-analysis was to provide an updated comparison between the currently available minimally invasive approaches (PCNL, laparoscopic [LP] and robotic pyelolithotomy [RP]) for the management of large renal stones. An electronic search of the current literature was conducted through the Medline and NCBI PubMed, Embase, Scopus and Cochrane Collaboration Central Register of Controlled Clinical Trials databases in March 2021. Studies about minimally-invasive treatment for kidney stones were considered. Inclusion criteria were: studies evaluating patients with large renal calculi (≥2 cm); the comparison of at least two of the three approaches (PCNL, LP, RP), and reporting data suitable for meta-analysis evaluation. Patients with concomitant management for ureteropelvic junction obstruction (UPJ-O) were excluded. Overall, 17 reports were considered for qualitative and quantitative synthesis, for a total cohort of 1079 patients, of which 534 with PCNL, 525 treated with LP, and 20 with RP. Of those, 16 compared PCNL with LP, while only 1 study compared LP with RP. PCNL mean operative time was statistically significantly shorter than LP and RP while mean estimated blood loss was statistically significantly higher for PNCL. No statistically significant differences were recorded among the three surgical approaches. Finally, PCNL demonstrated slightly, albeit statistically significant lower stone free rate when compared with LP. PCNL, LP and RP may be safely and efficiently used to manage large renal stones. All three procedures showed reasonably low rate of complications with a satisfactory stone clearance rate.

Robotic management of large stone disease: a case series.

The gold standard for urologic management of large stone disease traditionally has been percutaneous nephrolithotomy (PCNL). An alternative to PCNL is robotic pyelolithotomy (RP), which continues to gain traction. This study is a retrospective review of ten cases performed over a 2year period presenting operative outcomes for large stone disease treated with RP. The mean and standard deviation were calculated for age, body mass index, stone volume, stone diameter, pre-operative creatinine, operative time, robot-docked time, length of stay, post-operative creatinine, and estimated blood loss. In addition, results were collected for post-operative complications and secondary procedure requirements. Complete stone clearance was successful in 9 of 10 cases. The average renal function remained stable from a pre-operative creatinine of 0.917mg/dL to a post-operative creatinine level of 0.943mg/dL. This case series demonstrates that robotic assisted surgery has practical application when managing large stone disease.

Endoscopic-assisted robotic pyelolithotomy: a viable treatment option for complex pediatric nephrolithiasis

Endourological and percutaneous approaches are the standard of care for treatment of pediatric urolithiasis. However, in certain situations, an endoscopic-assisted robotic pyelolithotomy (EARP) can be an acceptable alternative. Limited data existon pediatric EARP; thus, the authors describe their experience. Patient selection: The authors retrospectively analyzed the records of all robotic procedures performed at five institutions from 7/09-10/17 to identify patients who underwent EARP. The authors collected demographics data, indications, operative time, and postoperative complications. Stone composition was reported as the majority composition (≥50%), unless any uric acid or struvite was noted, and those stones were classified as such. Through a traditional or hidden incision endoscopic surgery (HIdES) robot pyeloplasty approach, the authors are able to easily pass a flexible endoscope through a robotic trocar and into the renal collecting system to perform pyeloscopy or ureteroscopy. Stones were primarily retrieved via the pyelolotomy and, if indicated, treated with laser lithotripsy. The authors identified 26 patients who underwent EARP in 27 renal units. Median patient age was 12.2 years (interquartile range [IQR] 6.1-14.5 years), and body mass index was 17.5kg/m2 (IQR 16.5-25.4kg/m2). The median pre-operative dimension of the largest stone was 9.0mm (IQR 5.8mm-15.0mm). Reasons for EARP: 21 (77.8%) concomitant pyeloplasty, four (14.8%) altered anatomy precluding other techniques, and two (7.4%) multiple large stones. Multiple stones were present in 20 renal units (74.1%). Stones were located in the renal pelvis in nine (33.3%), lower pole in 10 (37.0%), ureter in one (3.7%), and multiple locations in seven (25.9%). Hidden incision endoscopic surgery approach was used in 14 (51.9%), and the median operative time was 237.5min (IQR 189.8-357.8min) with a median length of stay 1.0 day (IQR 1.0-2.0 days). Stone composition included calcium oxalate in 14 (51.9%), calcium phosphate in five (18.5%), cysteine in two (7.4%), struvite in two (7.4%), and unknown in four (14.8%). Overall stone free status was 19 (70.4%); of the eight (29.6%) renal units with residual stones, four underwent ureteroscopy, two extracorporeal shockwave lithotripsy (ESWL), one spontaneously passed, and one underwent percutaneous nephrolithotomy (PCNL). After secondary treatment, final stone free rate was 96.3%. Complications included stent migration and admission for urosepsis. At a median follow-up of 12 months (IQR 6.2-19.2 months), five (18.5%) had stone recurrence. Endoscopic-assisted robotic pyelolithotomy is a reasonable treatment option for select pediatric patients with concomitant ureteropelvic junction obstruction and nephrolithiasis or pediatric patients with stones inaccessible by standard methods.

Outcomes and peri-operative complications of robotic pyelolithotomy.

Standard of care for large or complex renal stones is percutaneous nephrolithotomy. Robotic pyelolithotomy, however, may be a feasible alternative, but limited data exist on its outcomes and complications. Our study objective was to describe the outcomes and peri-operative complications of robotic pyelolithotomy for complex renal calculi. We performed a retrospective analysis of robotic pyelolithotomy at our tertiary academic institution from 2015 to 2018. Demographics, stone clearance rates, complications, estimated blood loss, operative time, and length of stay were reported. 15 patients were included with a median age of 59years (SD 15.3, 27-80) and BMI 25kg/m2 (SD 4.6, 20.9-35.7). Median follow-up was 4months. Median stone size was 3cm (SD 1.2cm, 2-5cm). Concomitant pyeloplasty was performed in 2 patients, complete stone clearance in 11 (73%) cases and 4 out of 5 (80%) with a solitary stone. Median operative time was 191.5min (SD 64.8min, 110-303min), with no open conversion. Median EBL was 70ml (SD 65ml, 20-250ml) and median length of stay was 1day (SD 1day, 1-5days). Median change in creatinine and eGFR were - 0.02mg/dl and + 3ml/min/1.73m2. There were no cases of sepsis or post-operative fever and only one case of transfusion. Robotic pyelolithotomy appears safe and effective. Ultimately, less bleeding, lower septicemia, renal parenchymal preservation, and favorable stone-free rates in a single procedure make this as an attractive option in the management of select patients with large renal stone disease.

Robotic pyelolithotomy for the treatment of large renal stones: a single-center experience.

Few studies have reported robotic pyelolithotomy (RPL) series; furthermore, the most of all have reported small and single-center series. Herein we report our experience from 70 cases of complex kidney stones treated with RPL at our surgical center; this study reports the largest series of RPL in a minimal invasive experienced center. Between February 2016 and March 2018, 70 patients with complex renal stones (Guy's Stone Score: 4) underwent RPL and included in a prospectively maintained institutional database. Baseline characteristics, clinical data, perioperative data, postoperative data and stone free status were assessed by descriptive statistics. Of 70 patients, 72.85% presented renal pelvis stones. The mean maximum stone diameter was 33.1±14.5 mm (median 30 mm; interquartile range 22-40 mm). Mean total operative duration was 122.5±34.4 min (median 120 min; interquartile range 105-135 min). In two patients (2.8%), a grade III complications were noted; no major complications (grade IV-V) were noted. The complete SFR, after a single robotic procedure, was 92.8%. Our findings suggest that RPL is a safe, reproducible and minimally invasive approach as treatment of large renal stones when endoscopic treatment failed or was not available. RPL permits to achieve an excellent stone free status, in a single definitive procedure.

VJY06 - Robotic pyelolithotomy for multiple nephrolithiasis during partial nephrectomy

VJY06 - Robotic pyelolithotomy for multiple nephrolithiasis during partial nephrectomy

Robotic Pyelolithotomy, Extended Pyelolithotomy, Nephrolithotomy, and Anatrophic Nephrolithotomy.

We are a reporting on the indications, techniques, and limitations of robotic surgery in the management of renal stones disease. Robotic surgery is a good tool to manage large kidney and ureteral stones, particularly in patients with anatomic anomalies. We describe three techniques in managing staghorn kidney stones: robotic anatrophic nephrolithotomy, robotic pyelolithotomy, and robotic nephrolithotomy. Robotic pyelolithotomy (RP) is ideal for patients with large renal pelvis and partial staghorn stone with a wide extra-renal pelvis. Robotic nephrolithotomy (RN) is ideal for stones inside a calyceal diverticulum or a partial staghorn eroding into the renal parenchyma. Renal vascular control could be avoided in most of those surgeries. Robotic anatrophic nephrolithotomy (RAN) is the most complex procedure and is reserved for patients with complete staghorn stones when percutaneous approach was not successful or not feasible. Control of renal vasculature is required for RAN. For robotic kidney surgeries, patients are positioned in a lateral decubitus position. Four or five ports are placed based on the stone location and surgeon's preference. We prefer the trans-peritoneal approach as it gives us the optimal exposure. For RP and RN, hilar control is usually not required. The renal pelvis/ renal parenchyma is incised, and the stones are carefully removed. If needed intra-operative flexible nephoscopy can be used to remove residual stones fragments. The collecting system is closed using an absorbable suture. DJ stent if needed is placed in an antegrade fashion. For RAN, the kidney is fully mobilized, and hilar control is required to avoid excessive bleeding. The kidney is incised along Brodel's line and the stones are extracted. The kidney parenchyma is then closed using 1 or 2 layers. We achieved an almost 100% stone free rate with RP and RN. RAN remains a challenging procedure with a success rate around 70%. Robotic surgery is a viable option to manage large renal and ureteral stones particularly in situations where endoscopic approach is not successful or feasible.

Robotic Surgery for Large Renal Stones: Prospective Three Years Single-Institution Experience

This prospective study evaluates the role of robotic surgery in the management of large renal stones. Robotic renal stone surgery is safe and effective, and may be considered among the treatment options for large renal calculi in adults, especially for patients with concomitant ureteropelvic junction obstruction. The benefits brought by robotic systems include improved 3-D visualization, greater dexterity, precision, and increased range of motion. Thus, robotic pyelolithotomy has been recommended for the treatment of renal calculi with concurrent upper tract abnormalities. The efficacy and safety of robotic pyelolithotomy as a treatment of large renal pelvic stones and partial staghorn stones is evident in our study, with a substantially high stone clearance rate. We were able to complete the robotic procedures safely and successfully in all but one of our 38 patients, who was converted to open surgery due to bleeding and severe adhesions. Overall, we found this procedure feasible, safe, efficacious, and high yielding in the management of large renal stones, especially when the procedure is accompanied by renal pelvis reconstructive surgery.

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

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 ...

V6-02 ROBOTIC PYELOLITHOTOMY IN ECTOPIC PELVIC KIDNEY: SIDE DOCKING IN SUPINE POSITION AND A FOUR-ARM APPROACH

You have accessJournal of UrologyUrolithiasis1 Apr 2015V6-02 ROBOTIC PYELOLITHOTOMY IN ECTOPIC PELVIC KIDNEY: SIDE DOCKING IN SUPINE POSITION AND A FOUR-ARM APPROACH Ahmad Al-Marzouq, Rawan Al-Yousef, and Saad Aldousari Ahmad Al-MarzouqAhmad Al-Marzouq More articles by this author , Rawan Al-YousefRawan Al-Yousef More articles by this author , and Saad AldousariSaad Aldousari More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.467AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Ectopic kidney is a congenital malformation occurring in 1 in 900 births. Only about one in 10 of these are diagnosed. Patients with ectopic kidneys can be completely asymptomatic and discovered incidentally or they present with symptoms owing to urinary tract infection, obstructive uropathy or nephrolithiasis. Ectopic kidneys with renal pelvic stones can be challenging to treat. We report our experience in managing a case of ectopic pelvic kidney with a renal pelvic stone by robotic pyelolithotomy. Our objective is to present our approach to Robotic Pyelolithotomy in the management of renal pelvic stone in ectopic pelvic kidney. METHODS Our case is a 46 year old male with 2 months history of vague lower abdominal pain. No other urological symptoms. During his work-up a Computed Tomography (CT) scan showed left ectopic pelvic kidney with an 8 × 12 × 11 mm stone in an anomalous renal pelvis showing multiple compartments connected by narrow channels. Two attempts at flexible ureteroscopy (URS) failed to reach the stone. After placing a 4.7 French double J stent we proceeded with left pelvic robotic pyelolithotomy. Side docking was utilized with the patient in supine trendelenburg position. Port placements were similar to robotic assisted laparoscopic prostatectomy. RESULTS Docking time was 35 minutes and total Console time was 150 minutes. There were extensive adhesions in the region of the left pelvic kidney. Multiple attempts failed to follow the course of the ureter in order to locate the renal pelvis. We subsequently opened the renal pelvis directly and used the flexible cystoscope to basket the stone out the renal pelvis through a narrow infundibulum. Estimated Blood Loss (EBL) was < 100 mls. A suction drain was inserted. The patient was discharged in < 48 hours postoperatively after removal of the drain. CONCLUSIONS Stones in ectopic pelvic kidneys pose a great challenge due to altered surgical anatomy. Robotic pyelolithotomy is a safe and feasible approach providing exceptional exposure and easier dissection. It is imperative to have a detailed understanding of ectopic kidney anatomy to ensure safety and procedure success. Utilization of flexible cystoscopy aided in the localization and extraction of the stone in an anomalous renal pelvis. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e577 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ahmad Al-Marzouq More articles by this author Rawan Al-Yousef More articles by this author Saad Aldousari More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Combined Robotic Pyelolithotomy and Laser Lithotripsy for Staghorn Calculi

Combined Robotic Pyelolithotomy and Laser Lithotripsy for Staghorn Calculi

V9-11 ROBOTIC PYELOLITHOTOMY AND URETEROPELVIC JUNCTION REPAIR IN A CROSS FUSED ECTOPIC KIDNEY

You have accessJournal of UrologyTransplantation/Urolithiasis1 Apr 2014V9-11 ROBOTIC PYELOLITHOTOMY AND URETEROPELVIC JUNCTION REPAIR IN A CROSS FUSED ECTOPIC KIDNEY Robert Brown, Jayram Krishnan, Riccardo Autorino, Humberto Laydner, Homayoun Zargar, Octay Akca, Dinesh Samarasekera, Luis Felipe Brandao, Jihad Kaouk, Georges-Pascal Haber, and Robert Stein Robert BrownRobert Brown More articles by this author , Jayram KrishnanJayram Krishnan More articles by this author , Riccardo AutorinoRiccardo Autorino More articles by this author , Humberto LaydnerHumberto Laydner More articles by this author , Homayoun ZargarHomayoun Zargar More articles by this author , Octay AkcaOctay Akca More articles by this author , Dinesh SamarasekeraDinesh Samarasekera More articles by this author , Luis Felipe BrandaoLuis Felipe Brandao More articles by this author , Jihad KaoukJihad Kaouk More articles by this author , Georges-Pascal HaberGeorges-Pascal Haber More articles by this author , and Robert SteinRobert Stein More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.2318AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Cross fused renal ectopia is a rare congenital anomaly characterized by unilaterally located fused kidneys. For renal calculous disease in this patient population, shockwave lithotripsy (SWL) has a poor stone clearance rate due to inadequate urinary drainage. Percutaneous access is also difficult due to the intervening spine posteriorly and overlying bowel anteriorly. We report a case of robotic pyelolithotomy and ureteropelvic junction (UPJ) reconstruction in a patient with this anatomic variation. METHODS Our patient is a 46 year-old male with an L-shaped left-sided cross fused kidney. He also had duplication his fused segment with hydronephrosis of the lower pole moiety suggestive of a UPJ obstruction. He presented with a 1.7 cm, a 1.1 cm and a 6 mm stone that had failed treatment with SWL and ureteroscopy. A stent was placed into the lower pole moiety and the patient was placed in a modified flank position with the left side up. All ports were placed in the midline with 2 assistant ports for retraction. The robot was docked perpendicular to the patient. After identifying the cross fused segment, ureterolysis of the lower pole ureter was performed. Laparoscopic ultrasound was used to identify the renal stones. A vertical pyelotomy in the fused lower pole renal pelvis was created and stones were removed. Ultrasound identified the remaining renal stone in the upper pole moiety of the fused segment. A second pyelotomy was created and the final stone was removed. The UPJ of the lower pole moiety was dismembered and the ureter was spatulated. An Anderson-Hynes pyeloplasty was then completed over our previously placed ureteral stent and the pyelotomies were closed with 3-0 V-loc suture. RESULTS The patient tolerated the procedure well and was discharged home on post-operative day 3. Our operative time was 331 minutes with an estimated blood loss of 50 mL. His post-operative creatinine level was 0.85 mg/dl and at one-month follow up, his diuretic radionuclide scan demonstrated no evidence of urinary tract obstruction with a T1/2 of 12.9 minutes. CONCLUSIONS Robotic pyelolithotomy with ureteropelvic junction reconstruction can be considered in patients with cross fused ectopia and nephrolithiasis who have failed traditional treatment modalities. © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e849-e850 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Robert Brown More articles by this author Jayram Krishnan More articles by this author Riccardo Autorino More articles by this author Humberto Laydner More articles by this author Homayoun Zargar More articles by this author Octay Akca More articles by this author Dinesh Samarasekera More articles by this author Luis Felipe Brandao More articles by this author Jihad Kaouk More articles by this author Georges-Pascal Haber More articles by this author Robert Stein More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

V9-12 LAPROSCOPIC PYELOLITHOTOMY IN AN ECTOPIC PELVIC KIDNEY

placed into the lower pole moiety and the patient was placed in a modified flank position with the left side up. All ports were placed in the midline with 2 assistant ports for retraction. The robot was docked perpendicular to the patient. After identifying the cross fused segment, ureterolysis of the lower pole ureter was performed. Laparoscopic ultrasound was used to identify the renal stones. A vertical pyelotomy in the fused lower pole renal pelvis was created and stones were removed. Ultrasound identified the remaining renal stone in the upper pole moiety of the fused segment. A second pyelotomy was created and the final stone was removed. The UPJ of the lower pole moiety was dismembered and the ureter was spatulated. An Anderson-Hynes pyeloplasty was then completed over our previously placed ureteral stent and the pyelotomies were closed with 3-0 V-loc suture. RESULTS: The patient tolerated the procedure well and was discharged home on post-operative day 3. Our operative time was 331 minutes with an estimated blood loss of 50 mL. His post-operative creatinine level was 0.85 mg/dl and at one-month follow up, his diuretic radionuclide scan demonstrated no evidence of urinary tract obstruction with a T1/2 of 12.9 minutes. CONCLUSIONS: Robotic pyelolithotomy with ureteropelvic junction reconstruction can be considered in patients with cross fused ectopia and nephrolithiasis who have failed traditional treatment modalities.

Robotic nephrolithotomy and pyelolithotomy with utilization of the robotic ultrasound probe

The treatment of large renal stones in children can be challenging often requiring combination therapy and multiple procedures. The purpose of this video is to describe our technique of robotic nephrolithotomy and pyelolithotomy for complex renal stone disease in children, and to demonstrate the utility of the robotic ultrasound probe to aid with stone localization. Robotic nephrolithotomy/pyelolithotomy was carried out in four consecutive patients. A robotic ultrasound probe (Hitachi-Aloka, Tokyo, Japan) under console surgeon control was used in all cases. Two patients underwent robotic pyelolithotomy, one patient underwent robotic nephrolithotomy, whilst the fourth patient underwent robotic pyelolithotomy and nephrolithotomy along with Y-V pyeloplasty for concurrent ureteropelvic junction obstruction. Mean operative time, blood loss and hospital stay was 216 minutes, 37.5 mL and 2 days, respectively. The robotic ultrasound probe aided identification of calculi within the kidney in all cases. For nephroli¬thotomy it was helpful in planning the incision for nephrotomy. After nephrotomy or pyelotomy, stones were removed using a combination of robotic Maryland forceps, fenestrated grasper or Prograsp. Antegrade nephroscopy introduced through a laparoscopic port was used in all patients for confirmation of residual stone status. Two patients did not require a ureteral stent in the post-operative period. One patient had a minor complication (Clavien Grade 2 - dislodged malecot catheter). All patients were stone free at last follow-up. Robotic nephrolithotomy and pyelolithotomy with utilization of the robotic ultrasound probe offers a one-stop solution for complex renal stones with excellent stone-free rates.

Nephrolithiasis in “Back-to-back” Kidneys

A 57-year-old woman presented with a 1-week history of left lower quadrant pain and nausea and vomiting. Computed tomography without contrast demonstrated a left 2.3-cm calculus at the ureteropelvic junction and a 6-mm lower pole calculus. The kidneys were in the pelvis and oriented "back-to-back," with the lateral portions of the kidneys fused in the midline. To our knowledge, this is the first description of this renal fusion anomaly. The patient underwent robotic pyelolithotomy of the ureteropelvic junction calculus and subsequent flexible ureteroscopic laser lithotripsy of the lower pole calculus and ureteral stent placement through the assistant working port.