Category: Laparoscopic/ Robotic: Other
Introduction & Objective : Current standard of treatment for large or complex renal stones is percutaneous nephrolithotomy. Robotic pyelolithotomy, however, may be utilized for treating kidney stones as an alternative to percutaneous nephrolithotomy or flexible ureteroscopy, but limited data exists on its outcomes and complications. Our study objective was to describe the outcomes and peri-operative complications of robotic pyelolithotomy for complex renal calculi.
Methods : We performed a retrospective analysis of all patients undergoing robotic pyelolithotomy at our tertiary academic institution from 2015-2018. Demographic and peri-operative outcomes including stone clearance rates, complications (Clavien grade), estimated blood loss, operative time, and length of stay were analyzed and reported with frequency, medians, and standard deviation.
Results : A total of 15 patients were included in the analysis (9 male/ 6 female) with a median age and BMI of 59 years (SD 15.3, R 27-80) and 25 kg/m2 (SD 4.6, R 20.9-35.7), respectively (Table 1). Preoperative CT demonstrated a median stone size of 3 cm (SD 1.2 cm, R 2-5 cm). A concomitant pyeloplasty was performed in 2 patients due to a UPJ obstruction. Staghorn calculi were found in 7 patients (47%) and removed intact or with limited fragmentation. Multiple stones were found in 9 patients (60%). Median operative time was 191.5 minutes (SD 64.8 min, R 110- 303 min) without any case of open conversion. Complete stone clearance was achieved in 10 (71%) cases. Median EBL was 70 ml (SD 65 ml, R 20-250 ml) and median length of stay was 1 day (SD 1 day, R 1-5 days). No case required renal ischemia. All cases underwent intraoperative ureteral stent placement. There were no cases of sepsis. Median changes in creatinine and eGFR after surgery were -0.02 mg/dl and +3 ml/min/1.73 m2. Median follow up time was 4 months. Complication rates were 13% (Clavien 1, n=2), 27% (Clavien 2, n=4), 7% (Clavien 3a, n=1), and 7% (Clavien 3b, n=1).
Conclusions : Robotic pyelolithotomy appears safe and is a reasonable option for removing renal stones in select patients. This approach allows the removal of stones with limited fragmentation, low infection rates, and without the need to incise the parenchyma, reducing potential bleeding and nephron loss.
Daniel Sidhom– Medical Student, A.T. Still University School of Osteopathic Medicine in Arizona, Buena Park, California
Michael Schulster– Manhattan, New York
Kathryn Sturgeon– New York, New York
James Borin– Assistant Professor of Urology, New York University, New York, New York
Marc Bjurlin– Assistant Professor, NYU Langone Health, Brooklyn, New York
A.T. Still University School of Osteopathic Medicine in Arizona
Buena Park, California