Stone formation from nonabsorbable clip migration into the collecting system after robot-assisted partial nephrectomy

Area of Science:

• Urology
• Surgical Innovation
• Nephrology

Background:

• Robot-assisted partial nephrectomy is a common procedure for kidney tumors.
• Foreign body migration after minimally invasive surgery can lead to complications.
• Renal calculi formation can be associated with foreign bodies within the collecting system.

Purpose of the Study:

• To report a rare case of Weck Hem-o-lok clip migration after robot-assisted partial nephrectomy.
• To highlight the potential for clip migration to cause renal stone formation.
• To describe the successful endoscopic management of a migrated surgical clip and associated stone.

Main Methods:

• A patient presented with renal colic 2 years after robot-assisted partial nephrectomy.
• Computed tomography revealed a renal calculus and an embedded surgical clip.
• Endoscopic laser lithotripsy was used to fragment the stone, followed by clip dislodgement and extraction with a stone basket.

Main Results:

• A Weck Hem-o-lok clip was identified within the collecting system, acting as a nidus for stone formation.
• The migrated clip was successfully dislodged and removed using a flexible ureteroscope and laser fiber.
• The patient's renal colic was resolved after the endoscopic procedure.

Conclusions:

• Surgical clip migration is a rare but significant complication following robot-assisted partial nephrectomy.
• Endoscopic management with laser lithotripsy and stone baskets can effectively treat clip migration and associated stone formation.
• This case underscores the importance of vigilance for retained foreign bodies and their potential sequelae.