Korean J Urol.  2014 Jul;55(7):475-481. 10.4111/kju.2014.55.7.475.

Laparoscopic Stone Surgery With the Aid of Flexible Nephroscopy

• Jung JH
• Cho SY
• Jeong CW
• Jeong H
• Son H
• Woo SH
• Kim DK
• Min SH
• Oh SJ
• Kim HH
• Lee SB

• KMID: 1794577
• DOI: http://doi.org/10.4111/kju.2014.55.7.475

Abstract

PURPOSE
To report the outcome of laparoscopic pyelo- and ureterolithotomies with the aid of flexible nephroscopy.
MATERIALS AND METHODS
A retrospective analysis was performed in 71 patients with complex renal stones or large and impacted proximal ureteral stones. Patients underwent laparoscopic pyelo- or ureterolithotomies with or without the removal of small residual stones by use of flexible nephroscopy between July 2005 and July 2010. Operative success was defined as no residual stones in the intravenous pyelogram at 12 weeks postoperatively. Perioperative results and surgical outcomes were analyzed.
RESULTS
The patients' mean age was 54.7+/-13.7 years, and 53 males (74.6%) and 18 females (25.4%) were included. The mean maximal stone size was 19.4+/-9.4 mm. A total of 47 cases were complex renal stones and 24 cases were impacted ureteral stones. Mean operative time was 139.0+/-63.7 minutes. Stones were completely removed in 61 cases (85.9%), and no further ancillary treatment was needed for clinically insignificant residual fragments in 7 cases (9.9%). For complex renal stones, the complete stone-free rate and clinically significant stone-free rate were 80.9% and 93.6%, respectively. Multivariate analysis showed that the use of flexible nephroscopy for complex renal stones can reduce the risk of residual stones. A major complication occurred in one case, in which open conversion was performed.
CONCLUSIONS
Laparoscopic stone surgery is a safe and minimally invasive procedure with a high success rate, especially with the aid of flexible nephroscopy, and is not associated with procedure-specific complications.

Keyword

Cystoscopes; Kidney calculi; Laparoscopes; Ureteral calculi

MeSH Terms

Adolescent
Adult
Aged
Aged, 80 and over
Female
Humans
Kidney Calculi/pathology/radiography/*surgery
Laparoscopy/methods
Male
Middle Aged
Nephrostomy, Percutaneous/*methods
Retrospective Studies
Treatment Outcome
Ureteral Calculi/pathology/radiography/*surgery
Young Adult

Figure

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  FIG. 1 Placement of ports (A, B) for laparoscopic stone surgery in the right (C) and left (D) kidneys.

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  FIG. 2 Stone removal using laparoscopic graspers or right-angled clamps via an incision site (A) and the use of flexible nephroscopy to pick up residual stones (B).

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