Experience with robotic assisted laparoscopic surgery in upper tract urolithiasis

Ashok K Hemal, Rishi Nayyar, Narmada P Gupta, Lalgudi N Dorairajan
Canadian Journal of Urology 2010, 17 (4): 5299-305

OBJECTIVE: Early results indicate that robot assisted laparoscopic surgery (RALS) may be useful in managing upper tract (UT) urolithiasis. We reviewed our experience of managing 50 cases of UT urolithiasis with or without reconstruction using RALS.

MATERIALS AND METHODS: We performed a record review of 50 cases of RALS for UT urolithiasis performed in two institutions from July 2006 to June 2009. The RALS procedures included pyeloplasty with pyelolithotomy (29 cases), ureterolithotomy, tailoring and reimplantation for megaureters (5 cases), ureterolithotomy with ureteral stricture reconstruction (1 case), primary UT stone surgeries (8 cases), partial nephrectomy (1 case) and ablative surgeries (6 cases). Data pertaining to indications, operative details, and complications were analyzed.

RESULTS: The average operating time was 105 min (86 min-135 min) for pyeloplasty with pyelolithotomy, 140 min (115 min-195 min) for ureterolithotomy, tailoring and ureteroneocystostomy and 106 min (88 min-174 min) for extended pyelolithotomy (5 cases). Mean blood loss was 77 mL (50 mL-250 mL). Stone clearance rate was 93.2%. One case of extended pyelolithotomy had hematuria requiring selective angioembolization. There was one conversion and no other major complication.

CONCLUSIONS: RALS for UT urolithiasis is safe and efficacious. It is particularly useful when stone removal is combined with reconstruction. It is a reasonable alternative for treating a solitary partial staghorn or a large pelvic stone including those in pelvic/anomalous kidneys. RALS did not seem substantially better than pure laparoscopy for isolated ureterolithotomy and for nephrectomy for a nonfunctioning kidney. Its role in the treatment of large, multiple or complete staghorn calculi needs further investigation.

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