Robot-assisted anatrophic nephrolithotomy with renal hypothermia for managing staghorn calculi

Treatment of patients with staghorn calculi with percutaneous nephrolithotomy can be challenging, often necessitating multiple tracts or sessions for complete stone clearance. Although open anatrophic nephrolithotomy can result in higher stone-free rates, it is rarely performed because of increased morbidity. To provide a minimally invasive alternative, we developed the technique of robot-assisted anatrophic nephrolithotomy (RANL) incorporating ice slush for renal hypothermia. Three patients with staghorn calculi (mean total stone volume 12887.67 mm(3)) underwent RANL with iced cold ischemia. A GelPOINT™ port was used for ice slush insertion. Intracorporeal temperatures were <9°C within 30 minutes of cold ischemia. Mean console and cold ischemia times were 167 and 56.7 minutes, respectively. Mean blood loss was 100 mL. There were no complications. Two patients had residual fragments measuring 13 mm, and two 9 mm stones, respectively. RANL with iced cold ischemia is a safe and feasible option that may be considered in patients with staghorn stones. Further study is needed to refine the technique and assess long-term functional outcomes.