Ectopic Pyelolithotomy via a Combined Robotic and Endoscopic Approach

Abstract

Clinical History:

A 35-year-old man with a history of nephrolithiasis presented to the emergency department with abdominal pain was found to have a pelvic kidney with mild hydronephrosis attributed to a 3.1 cm staghorn calculus and 1.3 cm cluster of lower pole stones.

Physical Examination:

The patient's examination was only remarkable mild abdominal pain overlying his pelvic kidney.

Diagnosis:

Preoperative computed tomography angiography demonstrated that the ectopic kidney was anterior to the bifurcation of the iliac vessels with overlying bowel, thus making a percutaneous approach challenging. However, the anterior orientation of the renal pelvis appeared amenable to combined robot-assisted laparoscopic and endoscopic pyelolithotomy.

Intervention:

The kidney was accessed through a traditional pelvic surgery robotic port placement. The renal pelvis was incised to deliver the staghorn calculus in one specimen. A flexible cystoscope was then introduced through laparoscopic trocar and guided into the lower pole. These stones were removed a combination of basket extraction and aspiration through laparoscopic suction-irrigator. A ureteral stent was advanced through the pyelotomy into the bladder over guidewire. The renal pelvis was closed in a single layer with overlying reapproximation of perirenal fat and peritoneum.

Follow-Up/Outcomes:

The patient was discharged on postoperative day one after removal of his Foley catheter and Jackson–Pratt drain. He underwent an uneventful stent removal in the office 6 weeks postoperatively. This case demonstrated that combined robot-assisted and endoscopic pyelolithotomy can be a safe and effective approach for pelvic kidney stone cases that may not be amenable to a single treatment modality.

Consent Statement:

Authors have received patient consent for video recording/publication in advance of video recording of procedure.

Music Source: The music used in the video is under public domain: Vivaldi—“L'Estro Armonico, Op. 3, Concerto No. 12, in E major, for violin and strings, RV 265”

No competing financial interests exist.

Runtime of video: 4 mins 44 secs