Simultaneous Bilateral Laparoscopic Pyelolithotomy: a Case Series of Three Patients

Abstract

Several patients present with bilateral renal and ureteric stones with or without hydronephrosis and preserved renal functions. Simultaneous bilateral laparoscopic pyelolithotomy (SBLP) is hitherto, not performed and patients are operated metachronously. Here, we report 3 cases of transperitoneal SBLP in adult and paediatric patients. A 30-year-old gentleman had a recurrent large pelvic stone in the left kidney and a small one in the right; a 40-year-old man had left solitary pelvic calculus with small lower calyceal calculus and broken calcified stent parts in the renal pelvis and upper ureter on the other side. An 8-year-old boy had bilateral solitary renal pelvic stone. All 3 subjects had preserved calyces, mild hydronephrosis, moderate size extra-renal pelvis and preserved renal functions. SBLP under general anaesthesia was performed. Meticulous pyelotomy closure was done using Polygalactin suture 3–0 with intra-corporeal suturing after DJ stent insertion. Single abdominal drain FG 20 was placed in the pelvis in all subjects. Two out of three patients underwent successful removal of all stones on both sides. In the third patient (40-year man), multiple small calculi (< 5 mm) in the left kidney were left behind and the part of calcified broken stent was removed using a ureteroscope. The operative time was 2 h and 25 min on an average in these cases. The blood loss was minimal on an average less than 50 ml. The 3 illustrative cases have paved the path and the confidence to undertake simultaneous bilateral laparoscopic pyelolithotomy and uretero-lithotomy more frequently in other units at our institute. Laparoscopic nephrolithotomy in intra-renal pelvis may be more difficult and is being attempted in single side stones. To start with SBLP may be tried in extra-renal pelvic stones. Second side should only be proceeded on after timely and successful completion on one side.