Robotic-Assisted Pyelolithotomy in an Ectopic Pelvic Kidney

Abstract

Clinical History:

A 60-year-old female was found to have a 2 cm Ureteropelvic junction (UPJ) stone in an ectopic right pelvic kidney while undergoing evaluation for gross hematuria. She had no prior stone history and normal renal function.

Physical Exam:

Physical exam was unremarkable. Computed tomography (CT) Urogram revealed a medial, pelvic kidney with overlying bowel and posterior, tortuous ureter. Renal vein ran longitudinally along the anterior surface of the kidney.

Diagnosis:

A 2 cm UPJ stone in an ectopic right pelvic kidney.

Intervention:

Given tortuosity of the ureter and overlying bowel precluded an endoscopic approach, we proceeded with robotic-assisted pyelolithotomy. ¹ An open-ended ureteral catheter was advanced to allow for distension of the renal pelvis. After placing robotic trocars, peritoneum and Gerota’s fascia were dissected off the anterior surface of the kidney. Robotic Potts were used to enter the renal pelvis. No stone was visible, thus antegrade ureteroscopy was performed through a robotic port, demonstrating an impacted 2 cm lower pole stone. We performed antegrade ureteroscopy, laser lithotripsy, and basket-extraction. A robotic suction arm was employed to remove remaining dust. A double-J ureteral stent was placed antegrade, and pyelotomy was closed in a running fashion.

Follow-Up/Outcomes:

The patient had an uneventful postoperative course and CT at 6 weeks demonstrated no residual stone. Laparoscopic or robotic-assisted pyelolithotomy demonstrates higher stone free rates in pelvic kidneys compared with endoscopic treatment (97.2% vs 65.9%–84.9%). ² However, surgical approach should be decided based on patients’ anatomy, stone density and location, and surgeon experience.

Author Disclosure Statement:

The authors have no conflicts of interest to disclose.

Patient Consent Statement:

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

Music:

Music was obtained from www.pixabay.com and is no copyright music, free for use.

Exact Runtime of video: 5 min 00 sec.