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Laparoscopic - assisted transpyelic rigid nephroscopy - simple alternative when flexible ureteroscopy is not
Marcos Tobias-Machado1, Alexandre Kiyoshi Hidaka1, Igor Nunes-Silva1
1Departamento de Urologia, Faculdade de Medicina do ABC - FMABC - Santo André, São Paulo, Brasil.
Summary
Laparoscopic-assisted rigid nephroscopy offers a safe alternative for challenging kidney stone removal when other methods fail. This technique is feasible for complex cases, including ectopic kidneys, ensuring stone-free status.
Area of Science:
- Urology
- Minimally Invasive Surgery
- Nephrolithiasis Management
Background:
- Treatment of renal lithiasis can be challenging in specific anatomical variations like malrotated or ectopic kidneys and UPJ stenosis.
- Laparoscopy presents a viable option for managing complex renal calculus cases where conventional treatments have failed.
Observation:
- This study details a laparoscopic-assisted rigid nephroscopy technique via a transpyelic approach for caliceal lithiasis.
- Two cases are presented: one with a pelvic kidney after ESWL and PCNL failure, and another with a dilated infundibulum.
Findings:
- Successful calculus removal was achieved using a 30 Fr rigid nephroscope, with optimal angles between 60-90 degrees.
- Both procedures had an operative time of 180 minutes with no significant complications, leading to stone-free status at one-year follow-up.
Implications:
- Laparoscopic-assisted rigid nephroscopy is a safe and effective alternative for selected patients with difficult-to-treat kidney stones.
- This approach is particularly valuable when flexible endoscopy is unavailable or standard procedures are unlikely to achieve complete stone clearance.
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