K. K. Badani1, M. Fumo , S. Kaul , A. Shrivastava , F. Ogunfitidimi , S. Dusik Fenton , R. Littleton , J. O. Peabody , R. M. Sahabudin , K. Arumuga , N. Ashani , S. Murali , A. K. Hemal , M. Menon, 1 1 1 1 1, 1 1 2 2 2 2 11

1Vattikuti Urology Institute, Henry Ford Hospital, Detroit, USA, Institute of Urology and 2Nephrology, Hospital Kuala Lumpur, Malaysia

Introduction: Percutaneous nephrolithotomy (PCNL) is the treatment of choice for large renal calculi. Many reports suggest that laparoscopy can be an alternative to PCNL for treatment of these stones. We wished to evaluate the role and feasibility of laparoscopic extended pyelolithotomy with robotic assistance (REP) for the treatment of stag-horn calculi.

Method: Thirteen patients with stag-horn renal stones underwent REP over a
two-week period in March 2006. 12 patients had partial stag-horns and one had a complete stag-horn (minimum stone size 3.8 cm). A transperitoneal technique was utilized for access. An intra-sinus dissection of the renal pelvis and extension of the pyelotomy to the upper and lower pole infundibula was
necessary for stone removal. In 2 patients, a lower pole nephrotomy was
performed.

Result: All procedures were completed robotically without conversion to
laparoscopy or open surgery. The average age was 55.4 years, and 53% were female. The total operative time from Veress needle placement to skin closure was 158 minutes. Average blood loss was 100 cc: no patient required a postoperative transfusion, none had post-operative fever, and 1 patient had a transient ileus lasting 48h. The total console time was 108 minutes. Complete stone removal was accomplished in all patients except the one with a complete stag-horn. Post-operative pain was minimal, and compared favorably with patients undergoing PCNL.

Conclusion: REP is an effective treatment alternative to PCNL in some patients with stag-horn calculi. However, patients with complete stag-horn calculi may not be suitable candidates for this approach.

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