In the setting of an intrarenal pelvis, an additional instrument is needed to retract the posterior lip of the sinus. The extrarenal pelvis, however, rarely requires any retraction for its exposure. The pyelotomy is made on the pelvis using a laparoscopic knife or scissors. Occasionally, a grating sensation of the underlying stone can be felt.

The incision can be either linear or curvilinear depending upon the stone size and configuration, and the shape, location (intra or extra), and exposure of the pelvis.

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