Abstract
Introduction:
Laparoscopic pyelolithotomy could be challenging in case of pyelocaliceal staghorn stones trapped by a narrow caliceal neck. The video describes a laparoscopic concomitant renal cyst ablation and transpielic ballistic/ultrasound lithotripsy through a rigid nephroscope.
Materials and Methods:
A 55-year-old man had a complex cyst (12-cm Bosniak II) of the left kidney and five stones: four pelvic (1–2 cm) and one pyelocaliceal (2.5 cm). With the patient in a 45° flank position, four transperitoneal trocars were used. The retroperitoneum and the kidney were exposed. The cyst was drained and unroofed, and then we performed a pyelotomy. A flexible cystonephroscope was inserted trough a 10–12-mm trocar for easy removal of all pelvic stones but not the pyelocaliceal one, because of a narrow caliceal neck. We introduced, through a trocar, a rigid nephroscope directly into pyelotomy, and we attempted a ballistic lithotripsy to split the stone (Swiss LithoClast Master®; EMS). Largest fragments were extracted with a grasper. Antegrade Double-J stent was positioned and pelvis was repaired with 3-0 running suture.
Results and Conclusions:
Operative time was 155 minutes; intraoperative bleeding was <25 mL; discharge was in postoperative day 4; histological findings were negative for cancer. Double-J stent was removed in postoperative day 20. Follow-up excluded hydronephrosis, residual stones, and cyst relapse. Laparoscopic ablation of renal cyst has been well estabilished. 1 Introduction of a rigid nephroscope through pyelotomy is safe: it offers best water flow, better observation, and big working channel. LithoClast Master (percutaneous nephrolithotomy modality) could be useful to treat big stones trapped by a narrow caliceal neck. Laparoscopic approach avoids damage of both urotelium and renal parenchyma and offers advantage to treat quickly more concomitant disease. 2
No competing financial interests exist.
Runtime of video: 6 mins 20 secs
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