Combined Robotic Pyelolithotomy and Laser Lithotripsy for Staghorn Calculi

Achilles Ploumidis, MD, BSc, MSc, PhD, FEBU, Prodromos Philippou, MD, MA, FEBU, Andreas Skolarikos, MD, PhD, FEBU, Assos. Prof., Grigoris Athanasiadis, MD, FEBU, Shailesh Raina, MD, MBBS, MS, D. Urol(Ion), Antonios Ploumidis, MD, PhD, FEBU

Department of Urology, Athens Medical Center, Athens, Greece (Drs. Ac. Ploumidis, An. Ploumidis). Department of Urology, Apollonion Private Hospital, Nicosia, Cyprus (Dr. Philippou). University Department of Urology, Sismanoglio Hospital, Athens, Greece (Drs. Skolarikos, Athanasiadis). Department of Urology, Jaslok Hospital, Mumbai, India (Dr. Raina)


Introduction: Robotic-assisted pyelolithotomy (RAPL) has recently immerged as an alternative approach for the management of complex kidney stones. RAPL combines the benefits of minimally invasive surgery with the high stone clearance rates achieved by open lithotomy.

Case Description: We describe the successful combination of RAPL and Holmium laser lithotripsy for the management of a staghorn calculus in a 57-year-old man who had previously undergone a failed percutaneous nephrolithotomy.

Discussion and Conclusion: The 500-m Holmium laser fiber was navigated by the console surgeon, who also controlled the laser foot pedal, thus maximizing surgeon control of the procedure. The combination of robotically assisted laparoscopic surgery and Holmium laser lithotripsy is a feasible and safe management option for achieving clearance of complex renal stones. To the best of our knowledge, this appears to be the first reported case, confirming the safety and efficacy of this combined technique.

Key Words: Robotic pyelolithotomy, Holmium laser, Staghorn calculus

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