Robotic-assisted laparoscopic pyelolithotomy in a horseshoe kidney

Nephrolithiasis is one of the most common indications for surgery in patients with a horseshoe kidney. Robotic-assisted surgery has become a staple in urologic practice, yet its application in stone management is largely undefined. We present a patient with a horseshoe kidney, who underwent a robotic-assisted laparoscopic pyelolithotomy (RPL) to treat a 3 cm stone burden. This procedure allowed for safe access that could not be obtained with percutaneous nephrolithotomy (PCNL) and stone removal without fragmentation, which would have been challenging with traditional laparoscopy. We advocate for the use of robotic-assisted laparoscopic pyelolithotomy in cases of aberrant anatomy complicating a heavy stone burden.