Laparoscopic-Assisted Transperitoneal Percutaneous Nephrolithotomy for Renal Caliceal Diverticular Calculi

Abstract

Introduction:

The key to definitive treatment of caliceal diverticular calculi is the removal of the stone together with complete control of the diverticulum (either obliteration or improvement of drainage). This is not achieved with extracorporeal shockwave lithotripsy. A percutaneous nephrolithotomy (PCNL) becomes more challenging with complex diverticular anatomy, complex stone anatomy, or thin renal parenchyma. Herein, we present a symptomatic patient with a complex cystic caliceal diverticulum burdened with multiple-branched calculi having segments both within and proximal to the diverticulum. There are a variety of options for the management of symptomatic calculi in caliceal diverticula, each with utility in particular situations. Herein, we describe a laparoscopic-assisted transperitoneal PCNL technique to address the unusual combination of an anterior caliceal diverticulum together with multiple branched calculi having segments both within and proximal to the diverticulum.

Surgical Technique:

In a modified lithotomy position, standard transperitoneal laparoscopy was performed utilizing three 10-mm trocars. After mobilization of the colon medially, the cystic diverticulum was opened. An additional 12-mm trocar was placed to allow for transperitoneal PCNL into the diverticulum. Rigid nephroscopy, holmium laser lithotripsy, and stone extraction were performed, including laser enlargement of the diverticular neck and removal of stone burden proximal to the neck. A double-pigtail ureteral stent and Jackson–Pratt drain were placed.

Result:

This procedure was performed on one patient to achieve a stone-free status. As far as we know, this is the first report of laparoscopic-assisted transperitoneal PCNL for the management of caliceal diverticular calculi.

Conclusion:

Laparoscopic-assisted transperitoneal PCNL is a safe and viable alternative for the management of symptomatic stones encountered in anterior cystic caliceal diverticula with a narrow neck and complex branched calculi.

No competing financial interests exist.

Runtime of video: 8 min 30 sec