Laparoscopic pyelolithotomy

When is it needed?

Laparoscopic pyelolithotomy is a good option for larger stones located in the pelvis (pyelon), especially an extended one. In some cases, we can even use this procedure to treat staghorn renal stones. The surgery is also highly successful in cases where we also treat the ureteropelvic junction stenosis at the same time. In such cases, this surgery is combined with pyeloplasty after the stone extraction.

How is it performed?

In order to perform laparoscopic pyelolithotomy, we require 3-4 trocars inserted through the left or right side of the abdomen. After detaching the kidney from the surrounding tissue, and having broad imaging of the blood vessels, the renal pelvis, as well as the upper third of the ureter, we make an incision of the kidney pyelon, and remove the stone. We then insert a thin catheter (such as a double-J stent) which will temporarily drain the kidney and help reconnect the ureter to the renal pelvis. The removed stone is placed into an endoscopic bag, which is extracted through one of the trocar incisions. Then, a thin drainage tube is inserted in order to monitor possible post-operative bleeding, the remaining trocars are removed, and the incisions are stitched up.

What are the possible complications?

Complications in these surgeries are very rare. The most common possible complication is bleeding that might require a blood transfusion. There are also general risks of laparoscopic surgery, such as the damage of stomach organs, the diaphragm, or blood vessels. These risks are minimal and occur in less than 1% of all patients. Approximately 2% of laparoscopic pyelolithotomies require a conversion to the open surgical approach.