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Laparoscopic pyelolithotomy: An emerging tool for complex staghorn nephrolithiasis in high-risk patients.

Gandhi HR, Thomas A, Nair B, Pooleri G - Arab J Urol (2014)

Bottom Line: The stone-free rate decreased with greater stone burden, but the operative time, estimated blood loss and need for ancillary procedures increased with stone burden.No blood transfusion was required and one patient each in groups 2 and 4 had a urine leak.LP provides acceptable results in complex cases for managing renal stone disease with a larger stone burden in high-risk situations.

View Article: PubMed Central - PubMed

Affiliation: Department of Urology and Renal Transplantation, Amrita Institute of Medical Sciences, Kochi, Kerala, India.

ABSTRACT

Objectives: To evaluate the effectiveness of laparoscopic pyelolithotomy (LP) for staghorn stones (>3-4 cm) in patients with chronic liver disease or coronary artery disease.

Patients and methods: In all, 49 patients underwent LP; they were divided into four groups, with stones in group 1 in the renal pelvis only, in group 2 in the renal pelvis and one calyx, in group 3 in the renal pelvis and two calyces, and in group 4, in the renal pelvis and more than two calyces. Patient demography, stone characteristics, surgical outcomes and complications were evaluated.

Results: The mean stone-free rate in one session was 90% among all groups. The mean (SD) stone size was 4.27 (1.72) cm. The stone-free rate decreased with greater stone burden, but the operative time, estimated blood loss and need for ancillary procedures increased with stone burden. No blood transfusion was required and one patient each in groups 2 and 4 had a urine leak.

Conclusion: LP provides acceptable results in complex cases for managing renal stone disease with a larger stone burden in high-risk situations.

No MeSH data available.


Related in: MedlinePlus

Port placement for LP by the transperitoneal approach.
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f0005: Port placement for LP by the transperitoneal approach.

Mentions: Patients underwent LP via the standard transperitoneal approach (modified flank position) as previously described by Salvado et al. [7]; the port configuration is shown in Fig. 1. The large bowel was reflected medially after incising the peritoneum along the white line of Toldt. An avascular plane was created between the fusion fascia and Gerota’s fascia to trace the gonadal vessels and ureter, and to reach the hilum. Using the Gil-Vernet technique the renal hilum was explored, and the main renal vessels were identified and safeguarded. The classical modified Gil-Vernet technique was used for renal pelvic dissection, as shown in Fig. 2. A pyelotomy was done as in open surgery, in a V-shaped manner, and with the creation of a flap using needle electrocautery. Stones in the pelvis were then removed using stone-grasping forceps (Fig. 3). The entire pelvicalyceal system was evaluated using a flexible instrument (cystoscope) through one of the instrument ports, and calyceal stones were retrieved from the kidney using a tri-prong forceps, grasper or stone basket, through the cystoscope (Fig. 4). Retrieved stones were placed in a rubber-glove basket under vision (Fig. 3). Occasionally stones were found in calyces with a narrow infundibulum, which were accessed with the help of gentle dilatation using ureteric PTFE dilators from 8 to 12 F, sufficient to negotiate a flexible ureteroscope access sheath (9/11 F) and thus, with the use of minimal irrigation, stones can be fragmented to gravel or powder using the holmium-YAG laser (365 nm). In the initial few patients there was stone slippage, but stones were never lost in the peritoneal cavity. We routinely use a technique of pre-placing the handmade rubber-glove (No. 8) finger bag and safeguard the large pieces in that. Gravel was safely removed with suction.


Laparoscopic pyelolithotomy: An emerging tool for complex staghorn nephrolithiasis in high-risk patients.

Gandhi HR, Thomas A, Nair B, Pooleri G - Arab J Urol (2014)

Port placement for LP by the transperitoneal approach.
© Copyright Policy - CC BY-NC-ND
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4561920&req=5

f0005: Port placement for LP by the transperitoneal approach.
Mentions: Patients underwent LP via the standard transperitoneal approach (modified flank position) as previously described by Salvado et al. [7]; the port configuration is shown in Fig. 1. The large bowel was reflected medially after incising the peritoneum along the white line of Toldt. An avascular plane was created between the fusion fascia and Gerota’s fascia to trace the gonadal vessels and ureter, and to reach the hilum. Using the Gil-Vernet technique the renal hilum was explored, and the main renal vessels were identified and safeguarded. The classical modified Gil-Vernet technique was used for renal pelvic dissection, as shown in Fig. 2. A pyelotomy was done as in open surgery, in a V-shaped manner, and with the creation of a flap using needle electrocautery. Stones in the pelvis were then removed using stone-grasping forceps (Fig. 3). The entire pelvicalyceal system was evaluated using a flexible instrument (cystoscope) through one of the instrument ports, and calyceal stones were retrieved from the kidney using a tri-prong forceps, grasper or stone basket, through the cystoscope (Fig. 4). Retrieved stones were placed in a rubber-glove basket under vision (Fig. 3). Occasionally stones were found in calyces with a narrow infundibulum, which were accessed with the help of gentle dilatation using ureteric PTFE dilators from 8 to 12 F, sufficient to negotiate a flexible ureteroscope access sheath (9/11 F) and thus, with the use of minimal irrigation, stones can be fragmented to gravel or powder using the holmium-YAG laser (365 nm). In the initial few patients there was stone slippage, but stones were never lost in the peritoneal cavity. We routinely use a technique of pre-placing the handmade rubber-glove (No. 8) finger bag and safeguard the large pieces in that. Gravel was safely removed with suction.

Bottom Line: The stone-free rate decreased with greater stone burden, but the operative time, estimated blood loss and need for ancillary procedures increased with stone burden.No blood transfusion was required and one patient each in groups 2 and 4 had a urine leak.LP provides acceptable results in complex cases for managing renal stone disease with a larger stone burden in high-risk situations.

View Article: PubMed Central - PubMed

Affiliation: Department of Urology and Renal Transplantation, Amrita Institute of Medical Sciences, Kochi, Kerala, India.

ABSTRACT

Objectives: To evaluate the effectiveness of laparoscopic pyelolithotomy (LP) for staghorn stones (>3-4 cm) in patients with chronic liver disease or coronary artery disease.

Patients and methods: In all, 49 patients underwent LP; they were divided into four groups, with stones in group 1 in the renal pelvis only, in group 2 in the renal pelvis and one calyx, in group 3 in the renal pelvis and two calyces, and in group 4, in the renal pelvis and more than two calyces. Patient demography, stone characteristics, surgical outcomes and complications were evaluated.

Results: The mean stone-free rate in one session was 90% among all groups. The mean (SD) stone size was 4.27 (1.72) cm. The stone-free rate decreased with greater stone burden, but the operative time, estimated blood loss and need for ancillary procedures increased with stone burden. No blood transfusion was required and one patient each in groups 2 and 4 had a urine leak.

Conclusion: LP provides acceptable results in complex cases for managing renal stone disease with a larger stone burden in high-risk situations.

No MeSH data available.


Related in: MedlinePlus