Laparoscopic anatrophic nephrolithotomy for managing large staghorn calculi

Abstract

OBJECTIVES To evaluate the efficacy of a laparoscopic approach for managing large staghorn renal calculi. PATIENTS AND METHODS Laparoscopic transperitoneal anatrophic nephrolithotomy was used to duplicate open anatrophic nephrolithotomy in five patients (three men) with large staghorn renal stones unsuitable for percutaneous nephrolithotomy. Only the renal artery was clamped, using a bulldog clamp. The stone was removed through a nephrotomy incision on the Brodel line, which was closed using 3/0 polyglactin continuous sutures, and sutures were buttressed by haemostatic clips instead of knots. Intraoperative ultrasonography was used in the last two patients to evaluate residual stones. RESULTS The mean (range) stone size was 53 (45–65) mm, the patient age was 53 (45–58) years, and the warm ischaemia and operative duration were 32 (29–35) and 170 (120–225) min, respectively. No blood transfusion was needed during or after surgery. All of the procedures were uneventful and there was no urine leakage after surgery. Only an 8‐mm and a 6‐mm residual stone remained in the first and third patients, in the lower and middle calyces, respectively. Both of them were subsequently treated with shock wave lithotripsy. An intravenous pyelogram after surgery showed a functional corresponding renal unit, with a significant improvement in obstruction in all patients. CONCLUSION Laparoscopic anatrophic nephrolithotomy is a promising alternative for patients who are candidates for open surgery, with an acceptable stone‐free rate. While offering a minimally invasive approach, it can minimize the need for secondary invasive interventions. Further patients and a longer follow‐up are needed before this is suggested as the preferred method in selected patients in the future.

Laparoscopic management of a large staghorn stone

“…9 Simforoosh and colleagues published their five case series with LAN in 2007. 10 Although they confirmed the feasibility of LAN, only three patients were stone-free (60%). Unlike LP, LAN involves clamping of the renal hilum and incision of the renal parenchyma, which is associated with loss of functional parenchyma and renal insufficiency.…”

Anatrophic Nephrolithotomy for The Management of Large Complete Staghorn Calculi

“…The indications for open stone surgery include complete large staghorn stones not amenable to a reasonable attempts of PCNL and large complete staghorn stones with comorbidities like chronic obstructive airway diseases 17 . The other indications are failed endourological procedures, anatomical variations of the collecting system causing diffi cult access to PCNL, necessity of anatomical reconstruction of pelvi-ureteric junction and skeletal abnormalities like severe kyphoscoliosis 18,19 .…”

Treatment of the Infected Stone

“…63 A minimally invasive alternative to open ANL is laparoscopic and robotic ANL, which have recently been described. [54][55][56][57] In preparation for surgery, a noncontrast CT scan is obtained to delineate the anatomy and guide the surgical approach. A renogram should be obtained if there is concern for a poorly functioning renal unit, and nephrectomy considered if poor function is confirmed and the contralateral kidney is normal.…”