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Large T, Assmus MA, Valadon C, Emmott A, Forbes CM, Agarwal D, Nottingham C, Scotland K, Rivera M, Chew B, Krambeck A. A Multi-institutional Review of Single-access Percutaneous Nephrolithotomy for Complex Staghorn Stones. Eur Urol Focus 2021; 7:1170-1175. [PMID: 33384272 DOI: 10.1016/j.euf.2020.11.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 10/30/2020] [Accepted: 11/30/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND With the heterogeneous distribution of novel surgical technologies and variable physician training, there is a need to re-evaluate contemporary outcomes of percutaneous nephrolithotomy (PCNL) for complex staghorn stones. OBJECTIVE To evaluate contemporary outcomes of guideline-supported treatment for patients with staghorn kidney stones using single-access PCNL in multiple North American centers. DESIGN, SETTING AND PARTICIPANTS We performed a multi-institutional retrospective review of staghorn stones managed from January 1, 2017 to January 1, 2019, inclusive. We excluded patients with more than a single percutaneous access per renal unit and those who underwent a concomitant contralateral procedure. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Safety (Clavien-Dindo complications) and efficacy in terms of a strictly defined stone-free rate were examined for single-access PCNL performed on staghorn stones with a Guy's stone score of 3-4. RESULTS AND LIMITATIONS We evaluated 301 patients meeting the inclusion criteria with an average age of 57 yr (range 18-87). All stones had a Guy's stone score of 3 (36.2%) or 4 (63.8%). The mean (± standard deviation) stone burden was 191.4 ± 49.8 mm2. Of the 297 patients (98.6%) who underwent computed tomography on postoperative day 1, 132 (44.4%) showed no residual stone, 111 (37.3%) had a largest fragment <4 mm, and 54 (18.2%) had a fragment ≥4 mm after primary single-access PCNL. Secondary procedures were performed in 117 patients (38.9%). Imaging at 3 mo demonstrated that 210/257 patients (82%) were stone-free. The overall complication rate was 17.9%, with 11 patients (3.7%) experiencing Clavien-Dindo grade ≥3 complications. CONCLUSIONS Single-access PCNL for complex staghorn stones is safe and effective. High stone-free rates with minimal morbidity are achievable with current techniques. PATIENT SUMMARY This study confirms that single-access percutaneous nephrolithotomy provides excellent outcomes in the treatment of complex kidney stones. This surgical technique has both safe and effective outcomes that are reproducible across multiple centers in North America.
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Affiliation(s)
- Tim Large
- Department of Urology, Indiana University, Indianapolis, IN, USA
| | - Mark A Assmus
- Department of Urology, Indiana University, Indianapolis, IN, USA
| | - Crystal Valadon
- Department of Urology, Indiana University, Indianapolis, IN, USA
| | - Anthony Emmott
- Department of Urology, University of British Columbia, Vancouver, Canada
| | - Connor M Forbes
- Department of Urology, University of British Columbia, Vancouver, Canada
| | | | | | - Kymora Scotland
- Department of Urology, University of British Columbia, Vancouver, Canada
| | | | - Ben Chew
- Department of Urology, University of British Columbia, Vancouver, Canada
| | - Amy Krambeck
- Department of Urology, Indiana University, Indianapolis, IN, USA.
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Tan YG, Chen K, Sim ASP. Robotic anatrophic nephrolithotomy: An alternative in managing complex renal stone. UROLOGY VIDEO JOURNAL 2020. [DOI: 10.1016/j.urolvj.2020.100026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Flešárová S, Maženský D. Anatomical Comparison of the Renal Arteries in the Rabbit and European Hare. FOLIA VETERINARIA 2017. [DOI: 10.1515/fv-2017-0032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
The aim of this paper was to compare the level of origin of the renal arteries in the rabbit and hare. The study was carried out on ten adult rabbits and ten adult European hares using the corrosion cast technique. After the euthanasia, the vascular network was perfused with saline. Batson’s corrosion casting kit No. 17 was used as a casting medium. After polymerization of the medium, the maceration was carried out in KOH solution. We found variable levels of the origin of renal arteries in the rabbit, in the hare and between both species. In the rabbit, the right renal artery originated at the level of the second lumbar vertebra in 70 % of the cases and at the level of the first lumbar vertebra in 30 % of the cases, and the left-sided renal artery originated in 60 % of the cases at the level of the second lumbar vertebra and at the level of the third lumbar vertebra in 40 % of the cases. In the hare, the bilateral renal arteries originated at the level of the second lumbar vertebra. According to the results, it can be concluded that the origin level of the renal arteries from the abdominal aorta is more variable in the domesticated rabbit in comparison with the hare.
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Affiliation(s)
- S. Flešárová
- Department of Anatomy, Histology and Physiology, University of Veterinary Medicine and Pharmacy, Komenského 73, 041 81 Košice , Slovakia
| | - D. Maženský
- Department of Anatomy, Histology and Physiology, University of Veterinary Medicine and Pharmacy, Komenského 73, 041 81 Košice , Slovakia
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Robotic Anatrophic Nephrolithotomy Utilizing Near-infrared Fluorescence Image-guidance: Idea, Development, Exploration, Assessment, and Long-term Monitoring (IDEAL) Stage 0 Animal Model Study. Urology 2016; 94:117-22. [PMID: 27210569 DOI: 10.1016/j.urology.2016.04.051] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Revised: 04/11/2016] [Accepted: 04/29/2016] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To test the feasibility of robotic anatrophic nephrolithotomy (RANL) using near-infrared fluorescence (NIRF) image-guidance for treating staghorn stones, in an in vivo stone surgery model. METHODS We developed a novel technique of RANL in a preclinical setting following guidelines on safe surgical innovation from the Idea, Development, Exploration, Assessment, Long-term monitoring (IDEAL) collaborative. We performed 2 RANL procedures on 2 live Yorkshire porcine females (IDEAL stage 0 study). The robot was docked in the flank position and a mini-GelPOINT was placed periumbilically as an assistant port. A model staghorn "stone" was created in vivo by injecting low-viscosity DenMat precision material into the renal pelvis. NIRF image-guidance, following clamping of the posterior renal artery, was used to determine if an anatrophic plane could be identified. One procedure was assessed under cold ischemia, with ice-slush injected onto the renal surface via the mini-GelPOINT. RESULTS Both porcine subjects underwent RANL successfully. Replica staghorn models could be created reliably (mean size 5.1 cm; solidification time 2-3 minutes). NIRF image-guidance afforded clear vascular demarcation for precise scoring of an anatrophic plane in both kidneys. The staghorn models were removed in toto through the anatrophic incision in both subjects. Mean blood loss was 160 cc. Mean console and ischemia times were 114 minutes and 34.5 minutes, respectively; ice-slush hypothermia led to a renal surface temperature of 15.4°C. CONCLUSION In this IDEAL stage 0 preclinical study, we demonstrated that NIRF image-guidance is able to accurately identify the renal avascular plane, thus permitting an anatrophic approach for robotic excision of staghorn stones.
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Pastore AL, Palleschi G, Silvestri L, Leto A, Ripoli A, Fuschi A, Al Salhi Y, Autieri D, Petrozza V, Carbone A. Combined laparoscopic pyelolithotomy and endoscopic pyelolithotripsy for staghorn calculi: long-term follow-up results from a case series. Ther Adv Urol 2016; 8:3-8. [PMID: 26834835 DOI: 10.1177/1756287215607417] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
PURPOSE Staghorn renal stones are a challenging field in urology. Due to their high recurrence rates, particularly those associated with an infective process, a complete removal is the ultimate goal in their management. We report our experience with a combined approach of laparoscopic pyelolithotomy and endoscopic pyelolithotripsy, the stone clearance rate, and long-term, follow-up outcomes. METHODS From June 2012 to October 2014, nine adult patients with large staghorn renal calculi (mean size, 7.2 cm; range, 6.2-9.0 cm) underwent a combined laparoscopic and endoscopic approach. The technique comprised laparoscopic pyelolithotomy and holmium-YAG laser stone fragmentation with the use of a flexible cystoscope introduced through a 12 mm trocar. RESULTS The average operative time was 140 min (range, 90-190 min). The mean estimated hemoglobin loss was 0.6 mmol/l (range 0.5-0.7 mmol/l). None of the patients required an open- surgery conversion. The mean hospital stay was 4 days (range, 2-6 days). A computed tomography urogram control at 6 months of follow up did not show any stone recurrence. CONCLUSIONS Laparoscopic pyelolithotomy combined with endoscopic pyelolithotripsy could be a therapeutic option in cases where mini-invasive procedures, that is, extracorporeal shock wave lithotripsy, ureteroscopic lithotripsy, and percutaneous nephrolithotomy (PCNL) have failed. This technique has a high stone-clearance rate (75-100%) comparable with open surgery and PCNL. However, it could be technically demanding and should be performed by skilled laparoscopy surgeons.
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Affiliation(s)
- Antonio Luigi Pastore
- Department of Medico-Surgical Sciences and Biotechnologies, Urology Unit, ICOT, Faculty of Pharmacy and Medicine, Sapienza University of Rome, Via Franco Faggiana 1668, Latina 04100, Italy
| | - Giovanni Palleschi
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy and Uroresearch, No Profit Association for Scientific Research in Urology, Latina, Italy
| | - Luigi Silvestri
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy
| | - Antonino Leto
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy
| | - Andrea Ripoli
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy
| | - Andrea Fuschi
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy
| | - Yazan Al Salhi
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy
| | - Domenico Autieri
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy
| | - Vincenzo Petrozza
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy
| | - Antonio Carbone
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy and Uroresearch, No Profit Association for Scientific Research in Urology, Latina, Italy
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The role of open and laparoscopic stone surgery in the modern era of endourology. Nat Rev Urol 2015; 12:392-400. [DOI: 10.1038/nrurol.2015.141] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Abreu LDADS, Camilo-Silva DG, Fiedler G, Corguinha GB, Paiva MM, Pereira-Correia JA, Muller VJF. Review on renal recovery after anatrophic nephrolithotomy: Are we really healing our patients? World J Nephrol 2015; 4:105-110. [PMID: 25664252 PMCID: PMC4317620 DOI: 10.5527/wjn.v4.i1.105] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2014] [Revised: 10/02/2014] [Accepted: 11/19/2014] [Indexed: 02/06/2023] Open
Abstract
The main goals for urinary stone treatment are to preserve renal function, reduce or avoid complications related to calculi, and to render the patient free of calculi as soon as possible. Anatrophic nephrolithotomy (ANL) is a valid and useful alternative for conventional staghorn calculi excision. Although excellent stone free rates can be achieved with ANL there are some drawbacks that may be of concern. Morbidity related to intraoperative and postoperative complications is one of them. Another, great concern is the possibility of reduction on renal function related to the procedure itself. This may be related to nephron injury during nephrotomy and parenchymal closure or to ischemic injury. In this review we assess functional results after anatrophic nephrolithotomy.
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Khalaf I, Salih E, El-Mallah E, Farghal S, Abdel-Raouf A. The outcome of open renal stone surgery calls for limitation of its use: A single institution experience. AFRICAN JOURNAL OF UROLOGY 2013. [DOI: 10.1016/j.afju.2013.04.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Kawahara T, Ito H, Terao H, Kato Y, Ogawa T, Uemura H, Kubota Y, Matsuzaki J. Ureteroscopy-Assisted Retrograde Nephrostomy (UARN) after Anatrophic Nephrolithotomy. Case Rep Med 2012; 2012:164963. [PMID: 22924043 PMCID: PMC3424501 DOI: 10.1155/2012/164963] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2012] [Revised: 07/07/2012] [Accepted: 07/22/2012] [Indexed: 11/17/2022] Open
Abstract
Introduction. Open surgical anatrophic nephrolithotomy (ANL) had been the standard treatment for large renal calculi prior to the development of endoscopic devices and endoscopic techniques. A previous report described the efficacy of ureteroscopy-assisted retrograde nephrostomy (UARN) and presented a case of renal calculi successfully treated with UARN during percutaneous nephrolithotomy (PCNL) in a patient after ANL. Case Presentation. A 61-year-old male with left renal calculi was referred for further treatment. The patient was placed under general and epidural anesthesia, in a Galdakao-modified Valdivia position. A flexible ureteroscope (URS) was inserted, and a Lawson retrograde nephrostomy puncture wire was advanced into the flexible URS. The puncture wire then followed the route from the renal pelvis to the exit skin. Calculus fragmentation was undertaken using a pneumatic lithotripter. Conclusions. UARN for PCNL was therefore found to be a safe, effective, and appropriate treatment for a patient presenting with renal calculi after undergoing ANL.
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Affiliation(s)
- Takashi Kawahara
- Department of Urology, Ohguchi Higashi General Hospital, 2-19-1 Irie, Kanagawa-ku, Yokohama, Kanagawa, Japan
- Department of Urology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Hiroki Ito
- Department of Urology, Ohguchi Higashi General Hospital, 2-19-1 Irie, Kanagawa-ku, Yokohama, Kanagawa, Japan
- Department of Urology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Hideyuki Terao
- Department of Urology, Ohguchi Higashi General Hospital, 2-19-1 Irie, Kanagawa-ku, Yokohama, Kanagawa, Japan
| | - Yoshitake Kato
- Department of Urology, Ohguchi Higashi General Hospital, 2-19-1 Irie, Kanagawa-ku, Yokohama, Kanagawa, Japan
| | - Takehiko Ogawa
- Department of Urology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Hiroji Uemura
- Department of Urology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Yoshinobu Kubota
- Department of Urology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Junichi Matsuzaki
- Department of Urology, Ohguchi Higashi General Hospital, 2-19-1 Irie, Kanagawa-ku, Yokohama, Kanagawa, Japan
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El-Husseiny T, Buchholz N. The role of open stone surgery. Arab J Urol 2012; 10:284-8. [PMID: 26558038 PMCID: PMC4442944 DOI: 10.1016/j.aju.2012.03.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2012] [Revised: 03/14/2012] [Accepted: 03/15/2012] [Indexed: 11/18/2022] Open
Abstract
Objective To highlight the role of open stone surgery in the management of urolithiasis in the current era of minimally invasive therapies. The introduction and continuous development of extracorporeal shockwave lithotripsy (ESWL), ureterorenoscopy and percutaneous nephrolithotomy (PCNL) over the past 30 years have led to a significant change in the current management of urolithiasis, where the indications for open stone surgery have been narrowed significantly, making it a second- or third-line treatment option. Methods We reviewed the most recent guidelines published by the European Association of Urology and the American Urological Association, and reviewed reports through a MEDLINE search to identify the indications and current role of open stone surgery. Results From the MEDLINE search, it was obvious that the number of papers published on open renal stone surgery has decreased during the last three decades, soon after the introduction of ESWL and PCNL. Conclusion Although currently most patients with stones can be managed by minimally invasive therapy, we believe that open surgery still has a role, and therefore it is of great importance to recognise that a small group of patients with complex stone disease, and those with anatomical and physiological anomalies, will benefit from this treatment option.
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Affiliation(s)
- Tamer El-Husseiny
- Urology Department, New Cross Hospital, Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, UK
| | - Noor Buchholz
- Endourology and Stone Services, Barts and The London NHS Trust, London, UK
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Ganpule AP, Prashant J, Desai MR. Laparoscopic and robot-assisted surgery in the management of urinary lithiasis. Arab J Urol 2012; 10:32-9. [PMID: 26558002 PMCID: PMC4442910 DOI: 10.1016/j.aju.2011.12.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2011] [Revised: 12/07/2011] [Accepted: 12/07/2011] [Indexed: 01/19/2023] Open
Abstract
Objectives To review the current role of laparoscopy and robot-assisted laparoscopy for managing urinary lithiasis. Results The contemporary indications for laparoscopic stone management are: anatomical variations in location or shape of the kidney (pelvic kidney, horseshoe kidney and malrotated kidney); coexisting pathologies, e.g. pelvi-ureteric junction obstruction; and stones in a renal unit with lower ureteric obstruction. The laparoscopic approach allows the simultaneous management of both the pathologies. Symptomatic stones in diverticula not amenable to endourological intervention can be treated with laparoscopy. Large impacted pelvic and ureteric calculi with a functioning renal unit are an indication for laparoscopic ureterolithotomy or pyelolithotomy. This review of current reports suggests that in a selected group of patients with complex stone disease the laparoscopic approach offers good success rates with minimal complications. There are few reports of robotic procedures in stone disease but existing data suggest that it is feasible. Conclusion Laparoscopic surgery is effective for complex renal stones and offers excellent stone clearance rates with minimal morbidity. Laparoscopic surgery is complementary in managing these stones. Robot-assisted laparoscopic technique of urinary tract stone management is in its early stage of implementation and randomised trials that compare robot assisted outcomes with other minimally invasive techniques are needed.
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Affiliation(s)
| | - Jain Prashant
- Muljibhai Patel Urological Hospital, Nadiad, Gujarat, India
| | - Mahesh R Desai
- Muljibhai Patel Urological Hospital, Nadiad, Gujarat, India
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Abstract
To date, most cases of renal calculi have been managed with extracorporeal shockwave lithotripsy and endoscopic procedures. However, for complex renal stone conditions, these minimally invasive procedures may require multiple operative sessions. Open surgery is usually reserved as a salvage procedure, although it is invasive in nature. Laparoscopic treatment is well accepted in renal surgery. For stone disease, it can duplicate open surgical techniques such as pyelolithotomy, pyeloplasty, anatrophic nephrolithotomy, caliceal diverticulectomy and nephrectomy. Although the laparoscopic techniques for stone treatment are quite challenging, it is both feasible and safe. Laparoscopic treatment is a viable option for large renal stone treatment with an excellent stone-free rate, especially when patients require their stones to be treated within a single session. However, it is more invasive in nature than endourology procedures and so should be reserved as the last resort option for renal stone management in the modern endourology era.
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Affiliation(s)
- Kittinut Kijvikai
- Associate Professor, Department of Surgery, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, 270 Rama 6 Road, Tungphyatai, Rajathevee, Bangkok 10400, Thailand
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Abstract
PURPOSE OF REVIEW Although most ureteral and urinary stones are managed using endourologic techniques or shockwave lithotripsy in daily clinical practice, stone surgery has not completely disappeared. Laparoscopy, another minimally invasive treatment, is continuously gaining place in the treatment of urinary stones, mainly replacing open surgery. RECENT FINDINGS Indications for open or laparoscopic stone surgery are anatomic abnormalities, such as horseshoe kidneys, malrotated kidneys, ureteropelvic junction obstruction with stones, or ectopic kidneys; symptomatic stones in diverticula; extremely large stones and all those situations in which conventional endourologic procedures and extracorporeal shock-wave lithotripsy are not available or were unsuccessful or in those conditions where laparoscopy offers a priori the best solution to an endourologic complex condition. SUMMARY Laparoscopic surgery is effective for complex urinary stones and allows adjunctive procedures. It complements other minimally invasive procedures, and a need for open surgery has strongly diminished.
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Zhou L, Xuan Q, Wu B, Xiao J, Dong X, Huang T, Chen H, Zhu Y, Wu K. Retroperitoneal laparoscopic anatrophic nephrolithotomy for large staghorn calculi. Int J Urol 2010; 18:126-9. [DOI: 10.1111/j.1442-2042.2010.02688.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Sotelo R, Astigueta JC, Giedelman C, de Andrade R, Carmona O, Ramirez D, Clavijo R. Robotic extended pyelolithotomy for complete staghorn calculus. J Robot Surg 2010; 4:99-102. [PMID: 27628774 DOI: 10.1007/s11701-010-0192-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2010] [Accepted: 04/28/2010] [Indexed: 10/19/2022]
Abstract
Staghorn stones represent a therapeutic challenge to urologists. We present our experience with laparoscopic extended pyelolithotomy for treatment of staghorn and complex renal calculi in highly selected cases. This approach provides the principles of open surgery with the advantages of minimally invasive surgery. We describe our experience with robot-assisted extended pyelolithotomy for complex coralliform calculi. Since January 2007, robotic extended pyelolithotomy has been performed by transperitoneal approach in two patients with complete coralliform lithiasis (calculi average size 8 cm). One patient had history of percutaneous nephrolithotomy. Demographic and operative data were collected. All procedures were technically successful without need for open conversion. Mean estimated blood loss was 175 ml (range 50-300 ml), and mean operative time was 150 min (range 120-150 min). A perinephric drain was employed in one patient with duration of 5 days. Postoperative imaging confirmed complete stone clearance. Robotic extended pyelolithotomy is a feasible and reproducible procedure for removal of complete and partial staghorn calculi in selected patients with complex nephrolithiasis. This approach might limit the role of open surgery for these calculi, but further publications with more cases are necessary to further define its utility.
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Affiliation(s)
- Rene Sotelo
- Centro de Cirugía Robótica y de Invasión Mínima Unidad de Urología, Instituto Médico La Floresta, Calle Santa Ana Urbanización La Floresta, Annex B, 2nd Floor, Caracas, Venezuela.
| | - Juan Carlos Astigueta
- Centro de Cirugía Robótica y de Invasión Mínima Unidad de Urología, Instituto Médico La Floresta, Calle Santa Ana Urbanización La Floresta, Annex B, 2nd Floor, Caracas, Venezuela
| | - Camilo Giedelman
- Centro de Cirugía Robótica y de Invasión Mínima Unidad de Urología, Instituto Médico La Floresta, Calle Santa Ana Urbanización La Floresta, Annex B, 2nd Floor, Caracas, Venezuela
| | - Robert de Andrade
- Centro de Cirugía Robótica y de Invasión Mínima Unidad de Urología, Instituto Médico La Floresta, Calle Santa Ana Urbanización La Floresta, Annex B, 2nd Floor, Caracas, Venezuela
| | - Oswaldo Carmona
- Centro de Cirugía Robótica y de Invasión Mínima Unidad de Urología, Instituto Médico La Floresta, Calle Santa Ana Urbanización La Floresta, Annex B, 2nd Floor, Caracas, Venezuela
| | - Daniel Ramirez
- Centro de Cirugía Robótica y de Invasión Mínima Unidad de Urología, Instituto Médico La Floresta, Calle Santa Ana Urbanización La Floresta, Annex B, 2nd Floor, Caracas, Venezuela
| | - Rafael Clavijo
- Centro de Cirugía Robótica y de Invasión Mínima Unidad de Urología, Instituto Médico La Floresta, Calle Santa Ana Urbanización La Floresta, Annex B, 2nd Floor, Caracas, Venezuela
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Skolarikos A, Papatsoris AG, Albanis S, Assimos D. Laparoscopic urinary stone surgery: an updated evidence-based review. ACTA ACUST UNITED AC 2010; 38:337-44. [DOI: 10.1007/s00240-010-0275-4] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2010] [Accepted: 04/06/2010] [Indexed: 11/24/2022]
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Nadu A, Schatloff O, Morag R, Ramon J, Winkler H. Laparoscopic surgery for renal stones: is it indicated in the modern endourology era? Int Braz J Urol 2009; 35:9-17; discussion 17-8. [PMID: 19254393 DOI: 10.1590/s1677-55382009000100003] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/24/2008] [Indexed: 11/22/2022] Open
Abstract
PURPOSE To report the outcomes of laparoscopic surgery combined with endourological assistance for the treatment of renal stones in patients with associated anomalies of the urinary tract. To discuss the role of laparoscopy in kidney stone disease. MATERIALS AND METHODS Thirteen patients with renal stones and concomitant urinary anomalies underwent laparoscopic stone surgery combined with ancillary endourological assistance as needed. Their data were analyzed retrospectively including stone burden, associated malformations, perioperative complications and outcomes. RESULTS Encountered anomalies included ureteropelvic junction obstruction, horseshoe kidney, ectopic pelvic kidney, fussed-crossed ectopic kidney, and double collecting system. Treatment included laparoscopic pyeloplasty, pyelolithotomy, and nephrolithotomy combined with flexible nephroscopy and stone retrieval. Intraoperative complications were lost stones in the abdomen diagnosed in two patients during follow up. Mean number of stones removed was 12 (range 3 to 214). Stone free status was 77% (10/13) and 100% after one ancillary treatment in the remaining patients. One patient had a postoperative urinary leak managed conservatively. Laparoscopic pyeloplasty was successful in all patients according to clinical and dynamic renal scan parameters. CONCLUSIONS In carefully selected patients, laparoscopic and endourological techniques can be successfully combined in a one procedure solution that deals with complex stone disease and repairs underlying urinary anomalies.
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Affiliation(s)
- Andrei Nadu
- Department of Urology, The Chaim Sheba Medical Center, Tel Hashomer, Israel.
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Deger S, Tuellmann M, Schoenberger B, Winkelmann B, Peters R, Loening SA. Laparoscopic anatrophic nephrolithotomy. ACTA ACUST UNITED AC 2009; 38:263-5. [PMID: 15204386 DOI: 10.1080/00365590410028719] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Management of staghorn calculi is still a challenge. To combine the surgical principles of treatment with the minimal invasive access we performed a laparoscopic anatrophic nephrolithotomy in a female patient successfully. Patient was discharged free of stone on fifth postoperative day. No complications occurred.
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Affiliation(s)
- Serdar Deger
- Department of Urology, Charité Campus Mitte, Humboldt University of Berlin, Berlin, Germany.
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Bagetti Filho HJS, Pereira-Sampaio MA, Favorito LA, Sampaio FJB. Pig kidney: anatomical relationships between the renal venous arrangement and the kidney collecting system. J Urol 2008; 179:1627-30. [PMID: 18295250 DOI: 10.1016/j.juro.2007.11.040] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2007] [Indexed: 10/22/2022]
Abstract
PURPOSE We present a systematic study of the anatomical relationship between the intrarenal veins and the kidney collecting system in pigs. MATERIALS AND METHODS The intrarenal anatomy (collecting system and veins) was studied in 61, 3-dimensional endocasts of the kidney collecting system together with the intrarenal veins. RESULTS There are free anastomoses between the intrarenal veins. The interlobar veins unite to produce large venous trunks, which form the renal vein. In our study we observed 2 trunks (cranial and caudal) in 54 of the 61 cases (88.53%) and 3 trunks (cranial, middle and caudal) in 7 (11.47%). Only the ventral surfaces of the cranial and caudal poles were drained by large veins, while the dorsal surfaces emptied by anastomoses into the ventral interlobar veins. There were large veins in a close relationship to the ventral surface (90.16%) and to the dorsal surface (3.28%) of the ureteropelvic junction. In 33 of the 61 cases (54.10%) there was 1 or 2 small dorsal veins. CONCLUSIONS Although some results of intrarenal venous arrangement in pigs could not be completely transposed to humans, many similarities of pig and human kidneys support its use as the best animal model for urological procedures.
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Badani KK, Hemal AK, Fumo M, Kaul S, Shrivastava A, Rajendram AK, Yusoff NA, Sundram M, Woo S, Peabody JO, Mohamed SR, Menon M. Robotic extended pyelolithotomy for treatment of renal calculi: a feasibility study. World J Urol 2006; 24:198-201. [PMID: 16758250 DOI: 10.1007/s00345-006-0099-6] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2006] [Accepted: 04/18/2006] [Indexed: 12/23/2022] Open
Abstract
Percutaneous nephrolithotomy (PCNL) remains the treatment of choice for staghorn renal calculi. Many reports suggest that laparoscopy can be an alternative treatment for large renal stones. We wished to evaluate the role and feasibility of laparoscopic extended pyelolithotomy (REP) for treatment of staghorn calculi. Thirteen patients underwent REP for treatment of staghorn calculi over a 12-day period. Twelve patients had partial staghorn stones and one had a complete staghorn stone. All patients had pre-operative and post-operative imaging including KUB and computed tomography. All procedures were completed robotically without conversion to laparoscopy or open surgery. Mean operative time was 158 min and mean robotic console time was 108 min. Complete stone removal was accomplished in all patients except the one with a complete staghorn calculus. Estimated blood loss was 100 cc, and no patient required post-operative transfusion. REP is an effective treatment alternative to PCNL in some patients with staghorn calculi. However, patients with complete staghorn stones are not suitable candidates for this particular technique.
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Affiliation(s)
- Ketan K Badani
- Vattikuti Urology Institute, Henry Ford Hospital, K-9 Urology, 2799 W. Grand Blvd, Detroit, MI 48202, USA.
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Abstract
PURPOSE OF REVIEW In the last few decades, with the improvement in endourological surgery and the invention and evolution of extracorporeal shock-wave lithotripsy, the indications for open surgery in stone disease have become rare, although open surgery still has a role in selected cases. In this review we discuss the current indications of open surgery for the elimination of urinary calculi. RECENT FINDINGS A MEDLINE and MeSH search was performed to evaluate currently available guidelines on open stone surgery and identify the evidence-based medicine that support the role of open surgery in treating urinary lithiasis. The latest papers published on open stone surgery are reviewed and conclusions are drawn, based on their results. SUMMARY Open stone surgery should be avoided in most cases, but should be considered for those patients in whom a reasonable number of less invasive procedures would not be useful. The most common indications for open stone surgery include complex stone burden, failure of extracorporeal shock-wave lithotripsy or endourological treatment and anatomical abnormalities (such as ureteropelvic junction obstruction and infundibular stenosis with or without renal caliceal diverticulum). The level of evidence for the currently available guidelines is not adequate, mainly because of lack of properly designed, large prospective randomized trials that compare different treatment options.
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Affiliation(s)
- Gerasimos Alivizatos
- Second Department of Urology, Athens Medical School, Sismanoglio Hospital, Athens, Greece.
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Preminger GM, Assimos DG, Lingeman JE, Nakada SY, Pearle MS, Wolf JS. Chapter 1: AUA guideline on management of staghorn calculi: diagnosis and treatment recommendations. J Urol 2005; 173:1991-2000. [PMID: 15879803 DOI: 10.1097/01.ju.0000161171.67806.2a] [Citation(s) in RCA: 593] [Impact Index Per Article: 29.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Soares RS, Romanelli P, Sandoval MA, Salim MM, Tavora JE, Abelha DL. Retroperitoneoscopy for treatment of renal and ureteral stones. Int Braz J Urol 2005; 31:111-6. [PMID: 15877829 DOI: 10.1590/s1677-55382005000200004] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2004] [Accepted: 01/13/2005] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To assess the efficacy of retroperitoneoscopy for treating stones in the renal pelvis and proximal ureter. MATERIALS AND METHODS In the period from August 2003 to August 2004, 35 retroperitoneoscopies for treatment of urinary stones were performed on 34 patients. Fifteen patients (42%) had stones in the renal pelvis, and in 2 cases, there were associated stones in the upper caliceal group. Twenty patients (58%) had ureteral stones, all of them located above the iliac vessel. Twenty-five patients (71%) had previously undergone at least one session of extracorporeal lithotripsy and 8 patients (26%) also underwent ureteroscopy to attempt to remove the stone. Eight patients underwent retroperitoneoscopy as a primary procedure. Stone size ranged from 0.5 to 6 cm with a mean of 2.1 cm. RESULTS Retroperitoneoscopy was performed by lumbar approach with initial access conducted by open technique and creation of space by digital dissection. We used a 10-mm Hasson trocar for the optics, and 2 or 3 additional working ports placed under visualization. Following identification, the urinary tract was opened with a laparoscopic scalpel and the stone was removed intact. The urinary tract was closed with absorbable 4-0 suture and a Penrose drain was left in the retroperitoneum. In 17 patients (49%), a double-J stent was maintained postoperatively. Surgical time ranged from 60 to 260 minutes with a mean of 140 minutes. The mean hospital stay was 3 days (1-10 days). The mean length of retroperitoneal urinary drainage was 3 days (1-10 days). There were minor complications in 6 (17.6%) patients and 1 case of conversion due to technical difficulty. Thirty-three patients (94%) became stone free. CONCLUSION Retroperitoneoscopy is an effective, low-morbidity alternative for treatment of urinary stones.
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Affiliation(s)
- Rodrigo S Soares
- Section of Urology, Hospital da Previdência dos Servidores do Estado de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil.
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Affiliation(s)
- Sidney C Abreu
- Section of Laparoscopic and Robotic Surgery, Glickman Urological Institute, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA
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Cherullo EE, Gill IS, Ponsky LE, Banks KLW, Desai MM, Kaouk JH, Meraney AM, Skacel M, Sung GT. Laparoscopic ureterocalicostomy: a feasibility study. J Urol 2003; 169:2360-4. [PMID: 12771798 DOI: 10.1097/01.ju.0000058214.99086.37] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE Ureterocalicostomy is occasionally indicated for reconstruction of recurrent, recalcitrant ureteropelvic junction obstruction associated with postoperative fibrosis and a relatively inaccessible renal pelvis. We investigated the feasibility of performing laparoscopic ureterocalicostomy in a survival porcine model. Anatomical, histological and chronic functional outcomes were evaluated. MATERIALS AND METHODS Laparoscopic ureterocalicostomy was performed in 10 survival female swine. A ureteropelvic junction obstruction model was created by laparoscopic ligation of a 2 to 3 cm. segment of upper ureter. After an interval of complete ureteropelvic junction obstruction laparoscopic ureterocalicostomy was performed in a manner duplicating the steps of conventional open surgery. After transverse amputation of the lower renal pole end-to-end anastomosis of the proximal ureter to the inferior calix was formed by laparoscopic freehand suturing and knot-tying techniques. RESULTS Mean ureter stricture length was 2.2 cm. (range 1.7 to 3.1). Mean duration of obstruction before laparoscopic ureterocalicostomy was 6.3 days (range 2 to 18). Mean operative time for laparoscopic ureterocalicostomy was 165.3 minutes (range 105 to 240). Mean estimated blood loss was 145 cc (range 25 to 400). Mean stent duration in 6 pigs was 8.7 days (range 7 to 11). Excretory urograms demonstrated immediate function with symmetrical and unobstructed drainage in all operated renal units. At 4 to 8 weeks of followup no urine leaks were noted and histological examination documented complete urothelial healing without fibrosis or scar formation. CONCLUSIONS Laparoscopic ureterocalicostomy is technically feasible in the porcine model and it effectively duplicates the established principles of open surgery. Our technique further extends the application of laparoscopic surgery for difficult ureteropelvic junction obstruction.
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Affiliation(s)
- Edward E Cherullo
- Section of Laparoscopic and Minimally Invasive Surgery, Glickman Urological Institute and Minimally Invasive Surgery Center, Cleveland Clinic Foundation, Cleveland, Ohio, USA
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