Transperitoneal laparoscopic pyelolithotomy: initial experience

ABSTRACT

To define the feasibility, safety and efficacy of transperito-neal laparoscopic pyelolithotomy in treatment of renal pelvic stones. In the period between March 2004 and November 2006, 15 patients were subjected to Transperitoneal laparoscopic pyelolithotomy among them three had an associated upper calyceal stones [8-11 mm]. Inclusion criteria were single renal pelvic stone in partial or complete extrarenal pelvis [with or without associated single calyceal stone] with no history of previous ibsilateral upper tract open surgery or pyelonephritis. The mean stone size was 2.7 cm [range 2-3.5 cm]. Out of the fifteen patients, 4 patients were refractory to ESWL, one had a failed PCNL and the remaining ten patients were managed laparoscopically as first choice. All patients had a double J stent fixation. Transpyelotomy, a rigid nephroscope or short ureteroscope had been used to localize and remove associated calyceal stone. Transperitoneal laparoscopic stone removal was successful In 13 out of 15 patients [86.6%] while the remaining 2 patients [13.4%] had open conversion. The main reason for open conversion was extensive fibrosis. In laparoscopically successful patients, the operative time was ranged from 100-190 min [mean 135 min]. Estimated blood loss was 40-120 mL [mean 65 mL], analgesic intake was 150 +/- 75 mg of diclophenac sodium, hospital stay was 3.1 days and the postoperative urine leakage was ranged from 1-10 days [mean 2.3 days]. No major intraoperative or postoperative complications was detected, however minor postoperative complications in the form of a high grade fever, 3 days ileus and prolonged urinary leakage for 10 days were recorded in 3 patients and all were resobed conservatively. Transperitoneal laparoscopic pyelolithotomy is feasible, safe and effective in treatment of renal pelvis stones either primary or as a salvage procedure after failed ESWL or PCNL