Robot assisted partial nephrectomy is a safe and viable alternative to laparoscopic partial nephrectomy, providing equivalent early oncological outcomes and comparable morbidity to a traditional laparoscopic approach. Moreover robot assisted partial nephrectomy appears to offer the advantages of decreased hospital stay as well as significantly less intraoperative blood loss and shorter warm ischemia time, the latter of which may help to provide maximal preservation of renal reserve. In addition, operative parameters for robot assisted partial nephrectomy appear to be less affected by tumor complexity compared to laparoscopic partial nephrectomy. Interestingly while the advantages of robotic surgery have historically been believed to aid laparoscopic naïve surgeons, these data indicate that robot assisted partial nephrectomy may also benefit experienced laparoscopic surgeons.
Both dusting and fragmentation with extraction approaches to ureteroscopic stone treatment are effective. In fact, there is little evidence that one approach is better than the other. However, each does have relative advantages and disadvantages, which should be considered. Although dusting tends to be associated with shorter procedure times and a lower risk of ureteral damage, this approach may place the patient at increased risk for future stone events should all of the resultant debris not be expelled from the collecting system. The active removal associated with fragmentation with extraction, in contrast, may provide for a more complete initial stone clearance.
Despite increasing laser settings, adequate irrigation can maintain relatively stable temperatures within an in vitro ureteral system. As irrigation rates decrease, even lower power laser settings produce a clinically significant increase in maximum temperature, potentially causing ureteral tissue injury.
The LithoVue Single-Use Digital ureteroscope has comparable optical capabilities, deflection, and flow, making it a viable alternative to standard reusable fourth-generation flexible digital and fiberoptic ureteroscopes.
Tubeless percutaneous nephrolithotomy appears to be safe and efficacious in uneventful procedures, in children, in obese patients, in simultaneous bilateral procedures, in supracostal access and in renal units with coexisting anatomical anomalies. Nephrostomy tube placement should still be considered in certain cases such as those with more than 2 nephrostomy access tracts, those necessitating a second look and those with intraoperative complications such as significant bleeding or collecting system perforation.
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