Laparoscopic and Robotic Calyceal Diverticulectomy: Outcomes and Modifications of Technique

Abstract

Abstract

Objective:

To examine the technique and outcomes of robotic and laparoscopic calyceal diverticulectomy in the management of symptomatic calyceal diverticula at a single center.

Subjects and Methods:

Perioperative outcomes of six minimally invasive calyceal diverticulectomies (four laparoscopic and two robotic) between March 2011 and May 2014 were analyzed. Postoperative complications were categorized by Clavien–Dindo grade.

Results:

The median age of the cohort was 35 years (range, 24–51 years), and mean body mass index was 24 kg/m². All 6 patients were female and presented with ipsilateral flank pain, and 3 of the 6 had coexisting recurrent urinary tract infections attributed to the calyceal diverticulum. Five of the 6 patients had failed prior surgical intervention with either endoscopic intervention or extracorporeal shock wave lithotripsy. Hilar clamping was performed in 2 of the 6 cases, with a mean warm ischemia time of 12 minutes (range, 10–14 minutes). Mean operative time was 162 minutes (range, 121–270 minutes), with no intraoperative complications. Mean blood loss was 150 mL (range, 50–300 mL), with no blood transfusions. There was one Clavien grade 1 complication and no major (Clavien grade 3 or higher) complications. Mean hospital stay was 2 days (range, 1–4 days). Four of the 6 patients were seen in follow-up, and all had complete resolution of flank pain and urinary tract infections, with no residual stones on imaging.

Conclusions:

Laparoscopic and robotic calyceal diverticulectomies for symptomatic calyceal diverticulum are safe, effective treatment options for symptomatic calyceal diverticula.