Stone Surgery

Most urinary stones are now treated by endourologic techniques and shock wave lithotripsy. However, occasionally, in the select patient with a combination of unique anatomical location, laparoscopic surgery may be indicated. Van Cangh et al. initially reported the technique of laparoscopic nephrolithotomy in a patient with a 2 cm renal calculus who had previously failed extracorporeal shock wave lithotripsy and whose anteriorly located stone-baring calyx precluded percutaneous extraction (45).

Laparoscopic approach assisted by laparoscopic ultrasonography with color Doppler function facilitated accurate localization of the calculus and optimal selection of a relatively thin, avascular site for the nephrotomy, allowing complete stone fragment clearance.

Miller et al. reported laparoscopic approach for symptomatic caliceal diverticula with thin overlying renal parenchyma, or for anterior lesions inaccessible to endourolog-ical techniques (46). Laparoscopic ultrasonography was a crucial adjunct for stone localization, particularly when parenchyma was not thinned or the precise diverticular cavity site was not readily apparent. Laparoscopic ultrasonography may also aid in locating stones within the renal pelvis during laparoscopic nephro/pyelolithotomy (47). Gill et al. reported combining flexible laparoscopic nephroscopy and flexible laparoscopic ultra-sonography to identify calyceal calculi during laparoscopic ureterocalicostomy (48).

51 Tips for Dealing with Kidney Stones

51 Tips for Dealing with Kidney Stones

Do you have kidney stones? Do you think you do, but aren’t sure? Do you get them often, and need some preventative advice? 51 Tips for Dealing with Kidney Stones can help.

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