Laparoscopic Anatrophic Nephrolithotomy for Management of Complete Staghorn Renal Stone: Clinical Efficacy and Intermediate-Term Functional Outcome

Abstract

LAN is an alternative minimally invasive approach for one-session management of patients with complete staghorn renal stone. It offers an acceptable rate of stone clearance and operative complications but does incur a minimal loss of function in the affected kidney.

Clinical analysis of ureteroscopic holmium laser lithotripsy for the treatment of nephrolithiasis

“…The placement of flexible ureteroscope into the ureter and renal pelvis had been proved minimally invasive, safe, and highly effective for the treatment of ureter and renal stones. As compared with flexible ureteroscope, the other available treatment techniques, such as ESWL and PCNL, were difficult to perform and had poor therapeutic effects [5] . The management of nephrolithiasis in patients with the characteristics of gravel, multiple renal calculi, bleeding tendency, obesity, anomalous kidneys (horseshoe kidney, ectopic kidney, and kidney transplant), pregnant women, and other special patients imparted a special challenge to the treating urologist.…”

Treatment of the Infected Stone

“…53 Of the small series publishing their outcomes of robotic and laparoscopic ANL, reported complications include gross hematuria requiring continuous bladder irrigation, blood transfusion, splenic injury necessitating splenectomy, and vascular fistula. 54,56,85 Obstructive Pyelonephritis Patients with obstructive pyelonephritis are at risk to develop urosepsis and its sequelae, including acute kidney injury and death. Mortality rates for patients with obstructive pyelonephritis and sepsis are reported at 9% for those undergoing surgical decompression and 19% for those without decompression.…”

“…Stone free rates after open ANL are reported to be high, ranging from 80% to 100%. 90,91 Stone free rates after pure laparoscopic ANL are reported at 80% to 88%, 85,92 whereas early experience with the robotic-assisted laparoscopic approach reports fairly low stone free rates at 29% to 33%. 54,55 The presence of residual stone fragments in patients with infection stones composed of struvite and/or calcium carbonate apatite significantly increases the risk of stone recurrence, with a 0% to 10% recurrence rate for those who are stone free postoperatively versus 40% to 85% in the setting of residual stone fragments.…”

How are we doing with percutaneous nephrolithotomy (PCNL) in England?

“…Publication of low complication rates with equal efficacy in an outpatient setting has made ureteroscopic treatment of partial and staghorn renal calculi attractive. Even laparoscopic anatrophic nephrolithotomy has been advocated to further challenge the 'gold standard' treatment of PCNL [7]. It is therefore clinically important that British PCNL complication rates are low and that length of stay is decreasing to affirm the role that PCNL has with large renal calculi.…”

“…Surgeons performing robotic surgery need to develop the non-technical aspects alongside their technical skills, and full-immersion simulation certainly has a role to play in this and needs to be integrated within the curricula. The development of the Distributed Simulator offers a validated and low-cost method [7] of introducing full-immersion simulation into robotic surgery curricula and is an option that requires further investigation for its effectiveness in urology.…”