Retroperitoneal vs transperitoneal laparoscopic pyelolithotomy; a single surgeon's experience

Area of Science:

• Urology
• Minimally Invasive Surgery
• Nephrolithiasis Management

Background:

• Laparoscopic pyelolithotomy is a minimally invasive procedure for removing large renal pelvic stones.
• Both transperitoneal (TLPL) and retroperitoneal (RLPL) approaches are utilized, each with potential benefits and drawbacks.

Purpose of the Study:

• To compare the clinical outcomes of transperitoneal laparoscopic pyelolithotomy (TLPL) versus retroperitoneal laparoscopic pyelolithotomy (RLPL).
• To evaluate intraoperative and postoperative parameters in patients undergoing these procedures for large renal pelvic calculi.

Main Methods:

• A retrospective analysis of 104 consecutive laparoscopic pyelolithotomy surgeries for stones >20 mm.
• Patients were divided into two groups: TLPL (N=55) and RLPL (N=49).
• Comparison of operative time, hospital stay, hemoglobin drop, and postoperative fever rates.

Main Results:

• No significant differences in operative time or serum creatinine changes between TLPL and RLPL.
• TLPL was associated with significantly longer hospital stays (3.23 vs. 2.36 days).
• TLPL showed a greater hemoglobin drop (1.53 vs. 1.17 g/dL) and higher rates of postoperative fever (12.7% vs. 0.0%).

Conclusions:

• The retroperitoneal approach (RLPL) for laparoscopic pyelolithotomy resulted in shorter hospital stays and fewer postoperative complications.
• RLPL demonstrated reduced hemoglobin drops and significantly lower rates of postoperative fever compared to TLPL.
• Stone-free rates were comparable between the transperitoneal and retroperitoneal laparoscopic pyelolithotomy approaches.