LAPAROSCOPIC PYLOLITHOTOMY WITH ASSOCIATED RIGID CALICOSCOPY FOR MULTIPLE CALCULI

V16-02
J. B. Mendes1, M. T. Tanaka1, F. S. Silva, E. F. Pacagnan1, A. S. Tanaka, M. R. S. S. B. Mendes2

1Master Clínica, Cascavel, Brazil, 2Hospital Rondon, M C Rondon, Brasil, 3Unioeste, Cascavel, Brazil
Introduction: The Endourology development seems to rate the open pyelolithotomy as an obsolete treatment, despite the fact that some particular patients are hardly treated, even by these new technologies.

Method: A 34-year-old male patient with a previously inserted ureteral stent on the left side and showing an anteriorly rotated renal pelvis with four radiotransparent calculi, ranging from 1.3 to 1.6 cm, underwent a transperitoneal laparoscopic surgery using four port-sites. After a failed mobilization attempt by flushing the calyces with normal saline solution, a 30° rigid 4 mm telescope was used to explore all of the collecting system and then, not two, but three more caluli were found and removed under direct view. The pyelotomy was closed by running Vicryl suture. An external laminar drain and the ureteral stent were left behind.

Result: The surgery lasted 190 minutes and was uneventful. The pacient complained of minimal pain and stayed three days in the hospital. The laminar drain showed a slight urinary leakage. The ureteral stent was removed three weeks later.

Conclusion: The laparocopic approach seems to bring back the pyelolithotomy as a good option for selected patients, making the endourology even more effective to successfully treat them while keeping the same minimally invasive philosophy of treatment.