SCIENTIFIC PAPER Retroperitoneal Pyelolithotomy for Management of Renal Calculi Jagdish Chander, MBBS, MS, Manav Suryavanshi, MD, Pawan Lal, MD, Lakvinder Singh, MD, V. K. Ramteke, MBBS, MS ABSTRACT Objective: We evaluated the role of retroperitoneoscopic pyelolithotomy in the management of renal calculi. Methods: Fifty-six cases (male, 27; female, 29) of solitary or multiple renal calculi were evaluated in the study. There were 46 patients with a single calculus, 4 patients with a staghorn calculus, and 6 with a caliceal calculus. Retroperitoneoscopic pyelolithotomy was carried out after creating a retroperitoneal space with the balloon dissec- tion method. Pneumoretroperitoneum was maintained by carbon dioxide insufflation. Results: Stone clearance was achieved in all cases barring 2 cases of caliceal calculi that were converted to the open procedure. The postoperative hospital stay averaged 4 days. Patients were ambulatory within 24 hours and back to work within 7 days on average. Complications encoun- tered were peritoneal rent, subcutaneous emphysema, and superficial wound infection. The postoperative analgesic requirement averaged 100 mg of diclofenac (2 tablets). Conclusions: Retroperitoneoscopic pyelolithotomy is a safe, simple, and effective minimally invasive procedure and is a feasible option that can be recommended for management of renal calculi. Key Words: Laparoscopy, Retroperitoneal pyelolithot- omy, Renal calculi. Maulana Azad Medical College and Association, Lok Nayak Hospital, New Delhi, India (all authors). Address reprint requests to: Jagdish Chander, MBBS, MS, Warden’s flat, New Girls’ Hostel, Maulana Azad Medical College and Association, Lok Nayak Hospital, New Delhi 110 002, India. Telephone: 91 11 23235143, E-mail: drjchander@hotmail.com © 2005 by JSLS, Journal of the Society of Laparoendoscopic Surgeons. Published by the Society of Laparoendoscopic Surgeons, Inc. INTRODUCTION The last 2 decades have witnessed the development of minimally invasive treatment for urinary stones. With the advent of extracorporeal shock wave lithotripsy (ESWL), ureterorenoscopy (URS), and percutaneous nephrolithot- omy (PCNL), the role of open surgery has shrunk consid- erably. The role of laparoscopy is established for the removal of nonfunctioning kidneys and small-sized renal tumors.1–5 However, retroperitoneoscopic pyelolithotomy (RP) in the management of renal stones is yet to be evaluated, because very few centers throughout the world are performing this procedure. This study is an endeavor in this direction to evaluate the role of RP in the manage- ment of renal calculi. METHODS The study was conducted at the Department of Surgery, Maulana Azad Medical College and associated Lok Nayak Hospital, New Delhi, India from January 2001 to February 2002. The study included 56 cases of solitary or multiple renal calculi, with a male to female ratio 1:1.07 (male, 27; female, 29). There were 46 patients with a single stone in the renal pelvis, 4 patients with staghorn calculi, and 6 patients with caliceal calculi. The average size of stones was 2.75 cm (range, 1.5 to 4 cm). Two patients had a bifid renal pelvis, and another had renal vessels and the pelvis lying in the same plane. The mean age of the patients was 33.74 years (range, 18 to 60 years). Patients with recurrent and residual stones, bleeding diathesis, pregnancy, and congenital anomalies that precluded retroperitoneoscopy were excluded from our study. Technique Preoperatively, a double “J” ureteral stent was inserted in all patients under local anesthesia. Surgery was performed with all patients under general anesthesia. The patients were placed in the standard kidney position. The first port was inserted through a 15-mm incision made just below the tip of the 12th rib. The muscles were divided under vision, and the dorsolumbar fascia was incised and the retroperitoneal space entered. Blunt finger dissection was carried out posterior to the kidney. Wherever possible, JSLS (2005)9:97–101 97