[Nephroscopy with carbon dioxide in combination with laparoscopy in the treatment of urinary stones]

Laparoscopy in combination with nephroscopy is rarely used for the treatment of complex urinary stones or anatomical abnormalities with difficult access stones. During the nephroscopy, in an opened renal pelvis, large amounts of fluid leaks and collects in the peritoneal cavity and can be a drawback. In these cases, the nephroscopy with use of carbon dioxide (CO2) can be an alternative. We present our experience in with this technique.

We performed surgeries using the 3-port transperitoneal technique. Five patients with urolithiasis were included. Three patients had concomitant ureteropelvic junction stenosis, one with stones in ectopic kidney, and the third had a large stone impacted in the proximal ureter. Patients were treated by pyelolithotomy or ureterolithotomy combined with flexible nephroscopy using CO2 and dismembered pyeloplasty was performed in appropriate cases. A flexible cystoscope was passed through a port and guided laparascopically through the opening in the renal pelvis. The gas cannula was connected to the irrigation channel of the endoscope to insufflate CO2 and calculi were extracted with a nitinol basket.

Median age was 45 years (24-58). Mean operative time of nephroscopy was 22.4 minutes (range 15-48). Mean intra-operative blood loss was inestimable. There were no complications or conversion. Residual lithiasis requiring ureteroscopy was present in one patient.

Flexible nephroscopy using CO2 in combination with laparoscopy is a feasible and effective technique for the treatment of urinary stones in selected cases to avoid accumulation of fluid in the peritoneal cavity.