Bilateral Laparoscopic Transperitoneal Pyelolithomy: Dare You Do This?

Area of Science:

• Urology
• Minimally Invasive Surgery

Background:

• Bilateral large kidney stones, including staghorn stones (SS), present a surgical challenge.
• Traditional open surgery can lead to significant postoperative morbidity.

Observation:

• A 54-year-old patient with bilateral large stones, one being an SS, underwent a bilateral laparoscopic pyelolithotomy (LP).
• The procedure utilized a modified table tilt and five trocars for bilateral access.
• Calculi were delivered intact, with an operating time of 208 minutes and 250 mL blood loss.

Findings:

• The patient achieved a stone-free status post-procedure with stable serum creatinine.
• Hospital stay was limited to 3 days, with Double-J stents removed after 4 weeks.
• This case is the first report of bilateral LP for large and SS, demonstrating high stone-free rates.

Implications:

• Bilateral LP offers a minimally invasive option for complex kidney stone cases, potentially reducing postoperative morbidity.
• The technique appears safe and effective in expert hands, with potential for high stone-free rates.
• Further research is needed to confirm the reproducibility of this bilateral LP approach.