EURURO Vol. 72 No. 6

Surgery in Motion

Zero-fragment Nephrolithotomy: A Multi-center Evaluation of

Robotic Pyelolithotomy and Nephrolithotomy for Treating Renal

Stones

Ryan Swearingen

a ,

Akshay Sood

b ,

Rabii Madi

c ,

Zachary Klaassen

c ,

Ketan Badani

d ,

Jack S. Elder

[6_TD$DIFF]

Kyle Wood

e ,

Ashok Hemal

e ,

Khurshid R. Ghani

a , *

Department of Urology, University of Michigan, Ann Arbor, MI, USA;

Vattikuti Urology Institute, Henry Ford Health System, Detroit, MI, USA;

Department

of Urology, Medical College of Georgia, Augusta, GA, USA;

Department of Urology, Mount Sinai Hospital, New York, NY, USA;

Department of Urology, Wake

Forest Baptist Health, Winston-Salem, NC, USA

E U R O P E A N U R O L O G Y 7 2 ( 2 0 1 7 ) 1 0 1 4 – 1 0 2 1

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Article info

Article history:

Accepted October 13, 2016

Associate Editor:

James Catto

Keywords:

Kidney stone

Nephrolithotomy

Pyelolithotomy

Robotics

Urolithiasis

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Abstract

Background:

Robotic pyelolithotomy (RPL) and robotic nephrolithotomy (RNL) may be

utilized for treating kidney stones as an alternative to percutaneous nephrolithotomy or

flexible ureteroscopy.

Objective:

To describe the techniques of RPL and RNL, and present multi-center outcome

data for patients undergoing these procedures.

Design, setting, and participants:

This study was a retrospective analysis of 27 patients

undergoing RPL and RNL at five tertiary academic institutions between 2008 and 2014.

Surgical procedure:

RPL and RNL without use of renal ischemia.

Measurements:

We assessed stone clearance by visual assessment and postoperative

imaging. We also examined other factors, including complications (Clavien grade),

estimated blood loss, operative time, and length of stay.

Results and limitations:

Twenty-seven patients underwent 28 procedures for a mean

renal stone size of 2.74 cm (standard deviation: 1.4, range: 0.8–5.8). The mean stone

volume was 10.2 cm

. RPL accounted for 26 of these procedures. RNL was performed in

one patient, while another underwent combined RPL-RNL. Indications included failed

previous endourological management (13), staghorn calculi (five), gas containing stone

(one), calyceal diverticulum (one), complex urinary tract reconstruction (two), and

patient preference (four). The mean patient age was 35.6 yr and mean body mass index

was 25.5 kg/m

. Mean operative time/console times were 182 min and 128 min, re-

spectively. The mean estimated blood loss was 38 ml. The mean length of stay was 1.7 d.

There was no significant change in preoperative and postoperative serum creatinine

levels. The overall complication rate was 18.5% (Clavien 1 = 3.7%; 2 = 7.4%; 3b = 7.4%).

The complete stone-free rate was 96%.

Conclusions:

RPL and RNL are safe and reasonable options for removing renal stones in

select patients. In particular, RPL allows the removal of stones without transgressing the

parenchyma, reducing potential bleeding and nephron loss.

Patient summary:

The robotic approach allows for complete removal of the renal stone

without fragmentation, thereby maximizing chances for complete stone clearance in

one procedure.

Published by Elsevier B.V. on behalf of European Association of Urology.

* Corresponding author. Department of Urology, University of Michigan, NCRC Building 16, First

Floor, Room 114W, 2800 Plymouth Road, Ann Arbor, MI 48109-2900, USA. Tel. +1-734-615-4034;

Fax: +1-734-936-8037.

E-mail address:

kghani@med.umich.edu

(K.R. Ghani).

http://dx.doi.org/10.1016/j.eururo.2016.10.021

0302-2838/Published by Elsevier B.V. on behalf of European Association of Urology.