Nephro / Uretero Lithotomy – Robotic Assisted

Open/robotic surgery for large or complicated renal and/or ureteric calculi where all other techniques have failed. Seldomly done today. Only if no other options available.

• As a last resort to remove a large stone.
• Robotic would be considered first
• Where equipment is not available.
• Same entry as for open nephrectomy.

How is it done

• GA
• Entry ports for the robot will be determined by where the stone is
• A ureteric stent would already be in place, if not, this will be attempted prior to robotic access
• Kidney:
  • Usually an area of thinned cortex
  • Opened and stone removed
  • Closed
• Renal Pelvis:
  • Opened and stone removed
  • Closed
• Ureter:
  • Expose the area of the ureter
  • Compression of ureter above and below the calcalculus, as to prevent migration
  • Ureter opened
  • Stone removed
  • Closed
• Drain left

Alternatives

• PCNL.
• ESWL.
• Sandwich therapy: Combination of PCNL and ESWL.
• URSE with laser.

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