Robot-assisted laparoendoscopic single-site surgery for the simultaneous management of multiple urinary tract calculi: a case report and experience sharing

Abstract

BackgroundUrolithiasis is a clinically common benign disease in urology. Surgical treatments that are widely used in urolithiasis are percutaneous nephrolithotomy, rigid/flexible ureteroscopy, laparoscopic surgery, and endoscopic combined intrarenal surgery. The da Vinci surgical system is rarely used in the treatment of urolithiasis. In the current study, we report a case of multiple urinary tract calculi treated by robot-assisted laparoendoscopic single-site (RA-LESS) surgery.Case presentationA 49-year-old male patient was admitted to our hospital and diagnosed with multiple urinary tract calculi. He previously underwent right ureterolithotomy, laparoscopic cholecystectomy, and extracorporeal shockwave lithotripsy. Computed tomography (CT) scan and three-dimensional reconstruction CT image showed that multiple calculi were located in the right kidney, right upper ureter, and bladder. The preoperative glomerular filtration rate (GFR) were 17.81 ml/min (right kidney) and 53.11 ml/min (left kidney). We utilized the da Vinci system docking with a single-site port to perform pyelolithotomy, ureterolithotomy, and cystolithotomy, simultaneously. The operative time was 135 min and estimated blood loss was 30 ml. The postoperative hospital stay was 5 days. Three months after surgery, the serum creatinine and urea nitrogen levels dropped to a normal range, and no residual fragments were found in the CT scan. The postoperative GFR were 26.33 ml/min (right kidney) and 55.25 ml/min (left kidney).ConclusionsRA-LESS surgery is a safe and effective surgical procedure in the treatment of multiple urinary tract calculi; however, further investigation is needed to validate its long-term therapeutic effect.

Jackstone: A Calculus “Toy” in the Bladder. A Case Report of Rare Entity and Comprehensive Review of the Literature

“…Urolithiasis constitutes a major health problem with an estimated prevalence between 1 and 20% globally [6]. Bladder stones account for 5% of urinary calculi and can be generally classified into three distinct groups; migratory, primary, and secondary [7].…”

“…Modern surgical advancements have introduced minimally invasive approaches for vesical calculi removal, thus expanding the therapeutic scope [6,21]. Although being the gold standard for various urological pathologies, laparoscopic surgery has been rarely used for bladder lithiasis.…”

“…Although being the gold standard for various urological pathologies, laparoscopic surgery has been rarely used for bladder lithiasis. Fortunately, improvements in conventional laparoscopy have broadened this concept to a novel singlesite technique conferring minimal invasiveness and morbidity [6,22,23]. As such, laparo-endoscopic single-site surgery (LESS) gained traction as a promising alternative to traditional laparoscopy, and, in 2019, Zhang et al presented their compelling experience with robot-assisted LESS in a 49-yearold male with multiple urinary tract calculi.…”

“…As such, laparo-endoscopic single-site surgery (LESS) gained traction as a promising alternative to traditional laparoscopy, and, in 2019, Zhang et al presented their compelling experience with robot-assisted LESS in a 49-yearold male with multiple urinary tract calculi. The authors successfully removed three bladder stones along with three renal and one ureteral calculi through a single-site port without major complications [6]. Moreover, an innovative, safe, and efficient transvesical LESS (T-LESS) for intact mediumsize or multiple stone removal was illustrated by Roslan et al with the aid of a single-port device (Tri-Port+, Olympus, Hamburg, Germany) [22].…”