ROBOTIC PYELOLITHOTOMY AND PYELO-URETERAL PLASTY IN A PATIENT WITH PYELOURETERAL JUNCTION STENOSIS AND STAGHORN RENAL STONES

Aims: The treatment of staghorn renal stones can be very challenging, especially in patients with pyeloureteral junction stenosis who also require a pyelo-ureteral plasty. The robotic technology can be very useful in this setting, allowing to perform such difficult procedures with a minimally invasive approach. We present here a case of a full robotic right pyelolithotomy for staghorn renal stones and a contestual pyelo-ureteral plasty for pyeloureteral junction stenosis causing recurrent pyelonephritis. Methods: A 57-years old obese woman with a history of pyeloureteral junction stenosis from childhood and a finding of staghorn renal stones causing recurrent pyelonephritis was referred to our center. She underwent surgery with the use of the da Vinci Si surgical system. The patient was placed in a left sided position. The trocars were positioned according to the right-side trocars disposition suggested by Intuitive. Results: The procedure was successfully completed in 210 min. The right ureter was isolated and an intra-operative ultrasound scan was carried out to confirm the precise location of the stones. The pyelolithotomy was easily performed after resection of the stenotic tract, at pyeloureteral junction with the extraction of the stones. Then, another ultrasound scan was used to confirm the absence of residual stones. The pyelo-ureteral plasty was carried out with a PDS 5/0 running suture, prior stent placement. No conversion or intra-operative complications were recorded. The postoperative course was uneventful and the patient was discharged on the 4th postoperative day. Conclusions: The da Vinci Surgical System is a useful tool in the surgical treatment of staghorn renal stone disease and pyeloureteral junction stenosis. The enhanced surgical dexterity offered by robotic assistance allows to easily perform these challenging abdominal procedures with a minimally invasive approach, also in difficult cases such as obese patients or history of recurrent pyelonephritis.