Robotic Assisted Retroperitoneoscopic Pyelolithotomy for Staghorn Calculus
Ruth Blum, MD1; Ryan Dorin, MD2
1UConn Health, Farmington, CT; 2Hartford Healthcare Medical Group, Hartford, CT
Percutaneous nephrolithotomy (PCNL) is standard therapy for large (>2cm) or complex renal stones. However, it is associated with serious complications such as bleeding, sepsis and may result in failure to achieve stone free status. Retroperitoneal robotic pyelolithotomy is an alternative procedure with some advantages, including ease of access to kidney structures, greater exposure of the renal pelvis, decreased blood loss, and a higher stone free rate. This video demonstrates the utility of retroperitoneal robotic pyelolithotomy for a staghorn calculous.
A 72 year old, otherwise healthy male with a right-sided staghorn calculus elected to undergo a robotic assisted pyelolithotomy. The da Vinci Xi surgical system was used to perform the procedure. Access was obtained to the retroperitoneum with balloon dilation followed by trocar placement with the patient in full flank position. The renal pelvis, ureteropelvic junction, and ureter were exposed. A pyelotomy was made in the posterior renal pelvis. The stone was carefully extracted in its entirety. The collecting system was then repaired.
Total surgical time was 268 minutes, from first incision to skin closure. Estimated blood loss was 10mL. Stone analysis revealed a carbonate apatite stone (100%). The patient was discharged home on the first postoperative day. His JP drain and foley catheter were removed one week postoperatively and his ureteral stent was removed four weeks postoperatively. There have been no early postoperative complications.
This video presents a successful outcome of a retroperitoneal robotic pyelolithotomy. Retroperitoneal robotic pyelolithotomy is a safe and effective alternative to PCNL for select patients with large renal stones.
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