During ureteroscopic holmium laser lithotripsy, proximal migration of fragments and the inability to retrieve or release large stones entrapped within a stone basket can be problematic.
Benjamin K. Canales, Anup P. Ramani and Manoj Monga from Minneapolis, MN used a novel 1.5 French tipless basket ("Halo", Sacred Heart Medical) to overcome these limitations. The Halo basket has a unique rotary wheel on its handle that allows for rotation of an entrapped stone during holmium laser lithotripsy. Stone fragmentation can therefore proceed gradually on different areas of a large stone. The laser fiber is inserted through the working channel alongside this basket. The authors compared the Halo basket to the Microvasive 1.9 French Zerotip and the Cook 3 French Laser Flatwire, both in vitro and in a ureteral model. Stone fragmentation and flow through the working channel with and without a laser fiber were significantly better with the Halo basket, compared to both other baskets. Future trials should clarify if these advantages are also apparent in clinical practice.
Duke Herrell and his group from Vanderbilt University in Nashville, TN presented a series of complex laparoscopic reconstructive upper urinary tract procedures. Prior open and endoscopic procedures and anatomic variations (duplex kidney, pelvic kidney) were the main sources of complexity in these cases. Overall success was high at >80%, as defined by criteria that included a diuretic renal scan with a T1/2 of less than 10 minutes. Techniques like a renal pelvic flap repair and renal mobilization for a tension-free pyeloplasty after loss of a segment of viable ureter are among the highlights of this interesting video.