Outcomes and peri-operative complications of robotic pyelolithotomy

Standard of care for large or complex renal stones is percutaneous nephrolithotomy. Robotic pyelolithotomy, however, may be a feasible alternative, but limited data exist on its outcomes and complications. Our study objective was to describe the outcomes and peri-operative complications of robotic pyelolithotomy for complex renal calculi. We performed a retrospective analysis of robotic pyelolithotomy at our tertiary academic institution from 2015 to 2018. Demographics, stone clearance rates, complications, estimated blood loss, operative time, and length of stay were reported. 15 patients were included with a median age of 59 years (SD 15.3, 27-80) and BMI 25 kg/m² (SD 4.6, 20.9-35.7). Median follow-up was 4 months. Median stone size was 3 cm (SD 1.2 cm, 2-5 cm). Concomitant pyeloplasty was performed in 2 patients, complete stone clearance in 11 (73%) cases and 4 out of 5 (80%) with a solitary stone. Median operative time was 191.5 min (SD 64.8 min, 110-303 min), with no open conversion. Median EBL was 70 ml (SD 65 ml, 20-250 ml) and median length of stay was 1 day (SD 1 day, 1-5 days). Median change in creatinine and eGFR were - 0.02 mg/dl and + 3 ml/min/1.73 m². There were no cases of sepsis or post-operative fever and only one case of transfusion. Robotic pyelolithotomy appears safe and effective. Ultimately, less bleeding, lower septicemia, renal parenchymal preservation, and favorable stone-free rates in a single procedure make this as an attractive option in the management of select patients with large renal stone disease.