Case report of a giant kidney stone removed by transperitoneal laparoscopic pyelolithotomy

In cases of long-standing giant kidney stones resulting in irreversible loss of renal function, frequent urinary tract infections and a chronic flank pain that cannot be managed by other treatment options nephrectomy is considered the only effective treatment option. The largest KS documented in the literature weighed 2260 g and was treated by nephrectomy; while the largest stone removed without nephrectomy weighed 1350 g. There are no documented cases of KS over 200 g being removed by laparoscopic surgery. The preserved excretory function supported proceeding with pyelolithotomy rather than nephrectomy.

We hereby present a case of a giant KS in a functioning kidney of the female patient. She had previously (> 15 years ago) undergone an open left nephrolithotomy which made the procedure more challenging. She underwent successful transperitoneal laparoscopic pyelolithotomy.

The patient, aged 55, underwent an kidney-preserving transperitoneal laparoscopic left-sided pyelolithotomy due to the presence of a large staghorn stone in a functioning kidney. Because kidney function was salvageable, nephrectomy was not considered.

A successful kidney-preserving surgery was performed, without the occurrence of any surgical complications. The postoperative period was characterized by a brief duration of hospital stay.

Laparoscopic pyelolithotomy is a safe and effective surgical technique for the removal of large and complex KS. The minimally invasive approach ensures a rapid recovery process, minimal blood loss, reduced postoperative pain, and improved cosmetic results. However, it should be noted that the method requires highly skilled surgeons and advanced laparoscopic instruments were used (30° laparoscope, trocars, atraumatic graspers, maryland dissectors, monopolar/ultrasonic energy, and barbed suture for pyelotomy closure).