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• W2180662711 abstract "Introduction: A large complex staghorn renal calculus has been conventionally dealt with anatrophic pyelolithotomy or multiple access percutaneous nephrolithotomy.1 Although anatrophic nephrolithotomy has been attempted through a minimally invasive approach,2 this inflicts ischemic injury to the renal unit with a consequent nephron loss. Multiple access percutaneous nephrolithotomy may be associated with morbidities like blood loss, arteriovenous fistulas, iatrogenic injuries to the colon and incomplete clearance of calculi with a need for ancillary procedures. We demonstrate a minimally invasive approach that ensures a single-stage complete clearance of staghorn renal calculi with minimal morbidity and no ischemic impact on nephrons. Methods: Patients were evaluated in detail, including clinical, blood profile, and imaging (ultrasound, plain radiography, and CT urogram). Patients with a complex staghorn calculus and preserved parenchymal function underwent a laparoscopic approach through the transperitoneal route. An entry was gained into the Gerotas' fascia followed by identification of the renal hilum and the renal pedicle. After delineating the renal pelvis, an inverted U shaped pyelotomy is created. First attempt is made to remove the stone in toto. If nonretrievable, the staghorn stone is fragmented at major branch points using the lithotrite probe (EMS Lithoclast, probe inserted intracorporeally through the working port) and the major fragments are placed in a retrieval bag. Thereafter, the major caliceal extensions are fragmented using rigid ureteroscopy and lithoclast. Flexible ureteroscope is then inserted intracorporeally through the working port, the minor calices inspected for any residual calculi. After confirming complete clearance of calculi, a ureteric stent is inserted antegrade and the pyelotomy is closed. The ureteral stent is removed 6 weeks postprocedure. Imaging is repeated after the stent removal to ensure complete clearance of calculi. Results and Discussion: Between July 2012 and November 2012, three cases underwent a similar approach for the staghorn renal calculus. The mean age was 38.67 years. The mean body mass index was 23.4 kg/m2. All patients were males. The mean longitudinal stone size was 5.8 cm (range 4.8–7 cm). The laparoscopic approach was possible in all cases. The mean operation duration was 252.67 minutes. The mean blood loss was 95.67 mL. All patients recovered uneventfully. Ureteric stents were removed at 6 weeks postprocedure. In one case, a 7-mL lower caliceal fragment was detected on postprocedure imaging that was retrieved using flexible ureteroscopy during ureteric stent removal. In the other two cases, postoperative imaging revealed the complete clearance of calculi. All patients revealed a normal renal profile till last follow-up. Laparoscopic pyelolithotomy with intracorporeal lithotripsy and usage of rigid and flexible ureteroscopy is an effective option for single-stage management of the complex staghorn calculus. Intracorporeal lithotripsy facilitates removal of calculi that are unable to be retrieved in toto due to branching into calices. The procedure is well-tolerated with a negligible impact on nephrons. No competing financial interests exist. Runtime of video: 6 mins 44 secs" @default.
• W2180662711 created "2016-06-24" @default.
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• W2180662711 date "2013-08-01" @default.
• W2180662711 modified "2023-10-14" @default.
• W2180662711 title "Single-Stage Minimally Invasive Approach for Large Staghorn Renal Calculus: Points of Technique" @default.
• W2180662711 cites W1489637719 @default.
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• W2180662711 doi "https://doi.org/10.1089/vor.2012.0147" @default.
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