V6-12: 3D Laparoscopic Anatrophic Nephrolithotomy for Staghorn Calculi
The management of staghorn calculi and complete clearance remains technically challenging. SWL, PCNL or a combination therapy has limited efficacy. The stone free status may require several sessions of these procedures and might result in considerable morbidity. We had done laparoscopic anatrophic nephrolithotomy for a large staghorn calculi with complete stone clearance in one setting with preserved renal function. In this video presentation we show our technique of transperitoneal anatrophic nephrolithotomy for staghorn calculi.
A 64yrs male presented with right flank pain 6 months duration, fever on and off for 4 months. CT Urogram showed right staghorn calculus measuring 5.3*4.5cm (HU upto 797) without hydronephrosis, Patient was taken for right ANL, Right RGP and DJ placed before placing patient in left lateral decubitus position, standard ports inserted, colon reflected medial after incising peritoneum, kidney mobilized completely after opening gerota fascia, renal hilum dissected and clamp applied enbloc using laparoscopic satinsky. Nephrotomy incision given along the brodels line, PCS opened along the line of incision and all the calculus removed and placed in endobag. The parenchymal defect closed with 1-0 vicryl using continous no knotting suture using hemlock clips, stone clearance confirmed with post op X-Ray, DJ stent removed after 6 wks.
We had done a total 20 cases of lap anatrophic nephrolithotomy for staghorn calculus , mean stone size was 5.8cm, Mean blood loss 150ml, Mean warm ischemia time 20min, Mean operative time 140min, no intra operative or post operative complication. Complete stone clearance was achieved in all cases.
Laparoscopic anatrophic nephrolithotomy is feasible and a promising alternative for patients with large staghorn calculus, which offers complete stone clearance in a single operative session with minimal morbidity and well preserved renal function.