The role of robotic surgery in the management of renal tract calculi

Robotic-assisted laparoscopic pyelolithotomy with intracorporeal pyeloscopy in a horseshoe kidney

“… 2 Considering the increasing application of robotic-assisted techniques in urologic procedures, along with their associated benefits in complex stone removal, robot-assisted laparoscopic pyelolithotomy provided an effective method to treat this particularly complex patient. 3 , 4 , 5 Further, the minimally invasive nature of the robotic laparoscopic pyelolithotomy reduces the risk of postoperative complications. 2 Nephrolithiasis can be a common occurrence associated with congenital renal malformations, such as horseshoe kidneys, and the associated aberrant anatomy can complicate surgical interventions.…”

“… 2 In this context, the advantages of robotic-assisted surgery include expanded maneuverability, dexterity, and stability, which can prove beneficial in such cases as complex kidney stone removal due to aberrant anatomy. 3 The literature suggests that robotic pyelolithotomy is a safe option for the removal of large renal stones in patients that display anatomy with concurrent ureteropelvic junction obstruction. 4 Therefore, robotic-assisted laparoscopic pyelolithotomy can be considered an acceptable and appropriate technique for the safe and effective removal of a large stone burden from a horseshoe kidney.…”

Robot-assisted laparoscopic surgery for treatment of urinary tract stones in children: report of a multicenter international experience

“…Furthermore, ESWL is not recommended in children with stone burdens larger than 25 mm [21]. Laparoscopic and robot-assisted approaches have been reported as viable treatment options in selected patients with large stones, anomalies of collecting system and complex stone burdens [7][8][9][10]. These indications were supported by a conspicuous evidence in the adult population [13][14][15][16]22].…”

“…Use of flexible ureteroscope was very useful in case of multiple stones, staghorn stones or stones in a difficult location, such as a lower pole calyx, allowing to reposition the stone into a more convenient position or to use stone baskets to maximize the stone clearance [ 23 , 30 ]. The stone was retrieved using the robotic graspers, if it was easily visible in the renal pelvis or, alternatively, using endoscopic graspers or baskets [ 9 ]. Another important trick was to gently flush the calices and the renal pelvis using normal saline at the end of the procedure to wash all cavities and remove all fragments.…”

“…This is also supported by the European Association of Urology (EAU) guidelines for the management of urinary stone disease in children, stating that open or laparoscopic approach may be inevitable in such situations [ 8 ]. However, the morbidity of open surgery can be significant [ 9 ], whereas drawbacks of laparoscopic stone surgery include challenges with ureteral stenting, limited dissection and intra-corporeal suturing, as well as increased risk of complications such as urinary leakage [ 10 ].…”