Experience with robotic assisted laparoscopic surgery in upper tract urolithiasis

Area of Science:

• Urology
• Minimally Invasive Surgery
• Robotic Surgery

Background:

• Upper tract urolithiasis (UTU) management can be challenging.
• Robot-assisted laparoscopic surgery (RALS) is emerging as a potential treatment modality for UTU.

Purpose of the Study:

• To review the experience of managing 50 cases of UTU using RALS.
• To evaluate the safety and efficacy of RALS in UTU management, with or without reconstruction.

Main Methods:

• A retrospective record review of 50 RALS procedures for UTU.
• Procedures included pyeloplasty with pyelolithotomy, ureterolithotomy, tailoring and reimplantation for megaureters, ureteral stricture reconstruction, primary UT stone surgeries, partial nephrectomy, and ablative surgeries.
• Analysis of indications, operative details, and complications.

Main Results:

• Average operating times varied by procedure, with pyeloplasty/pyelolithotomy at 105 min and ureterolithotomy/tailoring/reimplantation at 140 min.
• Mean blood loss was 77 mL.
• Stone clearance rate was 93.2%, with one case requiring angioembolization for hematuria and one conversion to open surgery; no other major complications occurred.

Conclusions:

• RALS is safe and effective for UTU, particularly when combined with reconstructive procedures.
• It offers a reasonable alternative for specific cases like solitary partial staghorn or large pelvic stones.
• RALS showed no substantial advantage over pure laparoscopy for isolated ureterolithotomy or nephrectomy; its role in complex staghorn calculi requires further investigation.