Three-Dimensional Laparoscopic Anatrophic Nephrolithotomy

Abstract

Introduction:

The management of staghorn calculi and complete clearance remains technically challenging. Extracorporeal shockwave lithotripsy, percutaneous nephrolithotomy, or a combination therapy has limited efficacy. The stone-free status may require several sessions of these procedures and might result in considerable morbidity. We had done laparoscopic anatrophic nephrolithotomy for a large staghorn calculi with complete stone clearance in a single operative session with preserved renal function. In this video presentation, we show our technique of transperitoneal anatrophic nephrolithotomy for staghorn calculi.

Materials and Methods:

A 64-year-old male presented with right flank pain for 6 months duration and fever on and off for 4 months. CT urogram showed right staghorn calculus measuring 5.3 × 4.5 cm (HU up to 797) without hydronephrosis. The patient was taken for right anatrophic nephrolithotomy, right RGP and Double-J were placed before placing the patient in left lateral decubitus position, standard ports were inserted, colon reflected medial after incising peritoneum, kidney was mobilized completely after opening gerota fascia, renal hilum dissected, and clamp applied enbloc using laparoscopic satinsky. Nephrotomy incision was made along the brodels line, PCS opened along the line of incision, and all the calculus removed and placed in an endobag. The parenchymal defect was closed with 1-0 Vicryl using continuous no knotting suture using hemlock clips, stone clearance was confirmed with postoperative X-ray, and Double-J stent was removed after 6 weeks.

Results:

We had done a total of 20 cases of laparoscopic anatrophic nephrolithotomy for staghorn calculus, mean stone size was 5.8 cm, mean blood loss was 150 mL, mean warm ischemia time was 20 minutes, mean operative time was 140 minutes, and there was no intraoperative or postoperative complication. Complete stone clearance was achieved in all cases.

Conclusion:

Laparoscopic anatrophic nephrolithotomy is feasible and a promising alternative for patients with large staghorn calculus, which offers complete stone clearance in a single operative session with minimal morbidity and well-preserved renal function.

No competing financial interests exist.

Runtime of video: 6 mins 31 secs