Carson Wong1, Robert A Zimmerman. 1. Department of Urology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma 73104, USA. carson-wong@ouhsc.edu
Abstract
BACKGROUND AND PURPOSE: There are a variety of options for the management of symptomatic calculi in caliceal diverticula, each with utility in particular situations. Herein, we describe a laparoscopy-assisted transperitoneal percutaneous nephrolithotomy (PCNL) technique to address the unusual combination of an anterior caliceal diverticulum together with multiple branched calculi having segments both within and proximal to the diverticulum. TECHNIQUE: With the patient in a modified lithotomy position, standard transperitoneal laparoscopy was performed utilizing three 10-mm trocars. After mobilization of the colon medially, the cystic diverticulum was opened. An additional 12-mm trocar was placed to allow transperitoneal PCNL within the diverticulum. Rigid nephroscopy, holmium laser lithotripsy, and stone extraction were performed, including laser enlargement of the diverticular neck and removal of the stone burden proximal to the neck. A double-pigtail ureteral stent and Jackson-Pratt drain were placed. RESULTS: This procedure was successful in the only patient in whom it has been used to date. As far as we know, this is the first report of laparoscopy-assisted transperitoneal PCNL for the management of caliceal diverticular calculi. CONCLUSION: Laparoscopy-assisted transperitoneal PCNL is a safe and effective alternative for the management of symptomatic stones in anterior cystic caliceal diverticula with a narrow neck and complex branched calculi.
BACKGROUND AND PURPOSE: There are a variety of options for the management of symptomatic calculi in caliceal diverticula, each with utility in particular situations. Herein, we describe a laparoscopy-assisted transperitoneal percutaneous nephrolithotomy (PCNL) technique to address the unusual combination of an anterior caliceal diverticulum together with multiple branched calculi having segments both within and proximal to the diverticulum. TECHNIQUE: With the patient in a modified lithotomy position, standard transperitoneal laparoscopy was performed utilizing three 10-mm trocars. After mobilization of the colon medially, the cystic diverticulum was opened. An additional 12-mm trocar was placed to allow transperitoneal PCNL within the diverticulum. Rigid nephroscopy, holmium laser lithotripsy, and stone extraction were performed, including laser enlargement of the diverticular neck and removal of the stone burden proximal to the neck. A double-pigtail ureteral stent and Jackson-Pratt drain were placed. RESULTS: This procedure was successful in the only patient in whom it has been used to date. As far as we know, this is the first report of laparoscopy-assisted transperitoneal PCNL for the management of caliceal diverticular calculi. CONCLUSION: Laparoscopy-assisted transperitoneal PCNL is a safe and effective alternative for the management of symptomatic stones in anterior cystic caliceal diverticula with a narrow neck and complex branched calculi.
Authors: Ana Catarina Fragoso; Henry Steyaert; Pierre Arnaud; Ciro Esposito; Jose Estevao-Costa; Jean-Stephane Valla Journal: Transl Pediatr Date: 2016-10
Authors: Marco Amato; Pietro Piazza; Yves Deruyver; Lina Del Favero; Thomas Van den Broeck; Luca Sarchi; Simone Scarcella; Carlo Andrea Bravi; Stefano Puliatti; Salvatore Micali; Carl Van Haute; Ben Van Cleynenbreugel Journal: CEN Case Rep Date: 2022-01-04