“Vaginal Delivery”: A Novel Extraction Route for Large Renal Calculi Encountered During Laparoscopic Pyeloplasty

Abstract

Background: To describe a simple, novel stone extraction technique using the transvaginal route for large renal calculi encountered during laparoscopic/robotic pyelolithotomy. Methods: After a standard approach laparoscopic pyelolithotomy in a patient with a large (42 × 36 mm) pelvic calculus, Anderson-Hynes pyeloplasty was performed. A transverse posterior colpotomy was performed laparoscopically with the assistance of the Colpassist Vaginal Positioning Device (Boston Scientific) and the calculus was extracted, intact, through the vagina with the aid of an endoscopic retrieval bag. The vaginal incision was then closed intra-corporeally. A systematic review on the topic was also performed. Results: The stone was removed in its entirety through an occult vaginal incision. There were no complications reported and the patient was stone free at follow-ups. Conclusions: This simple, novel technique is an easily reproducible method, for the removal of large urinary calculi during either traditional laparoscopic or robotic-assisted laparoscopic stone surgery in the appropriate female patient. It avoids the need for additional abdominal incisions or complex techniques involving lithotripsy which may be more complicated and time consuming. All previously published stone extraction techniques for large calculi (greater than 20 mm) within this systematic review are also critically appraised.

Robotic Full Lobe Hepatectomy With Natural Orifice Extraction

“…Natural orifice specimen extraction has been described by a variety of surgical specialties including colorectal surgery, urological surgery, gynecologic surgery, hepatobiliary surgery, and abdominal transplantation. 5 – 9 The first transvaginal extraction for a cholecystectomy was performed in 1993 and nephrectomy with transvaginal extraction in 2002. 10 , 11 Since that time, there have been numerous case reports and series demonstrating the safety of transvaginal specimen extraction.…”