Laparoscopic pyelolithotomy in a malrotated kidney

Abstract Introduction Whilst advances in endourology have led to the popularization of percutaneous nephrolithotomy (PCNL) and retrograde intrarenal surgery (RIRS), laparoscopic pyelolithotomy (LPL) is a viable surgical option that is often underutilized despite its wide range of applications. We report our preliminary experience with laparoscopic pyelolithotomy for the treatment of multiple stones within a malrotated kidney. Methods The patient is a 60 year-old Chinese male with a 2.4 centimetre obstructing left renal pelvis calculus, as well as two left lower pole calyceal calculi up to 6 millimetres. A retrograde pyelogram and ureteric catheter insertion was first performed in lithotomy. The patient was then repositioned to flank position with the left side up at 30 degrees. Port placement comprised the camera port at the umbilicus and two further working ports at the left hypochondrium and left flank at the mid-clavicular line. Laparoscopic pyelolithotomy was performed and all 3 stones were retrieved intact. Results Total operative time was 209 minutes. Recovery was uneventful and the patient was confirmed as stone-free on post-operative imaging. Removal of the drain and indwelling catheter was performed on day 1 and day 7 respectively. The patient was medically fit for discharge on post-operative day 2. Outpatient retrieval of the ureteric stent was performed at 6 weeks. Conclusion Laparoscopic pyelolithotomy is a good option with high stone-free rates and minimal morbidity for malrotated kidneys wherein percutaneous methods are associated with difficult or risky access.