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Inicio Actas Urológicas Españolas (English Edition) Nephroscopy with carbon dioxide in combination with laparoscopy in the treatment...
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Vol. 36. Issue 3.
Pages 186-190 (March 2012)
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Vol. 36. Issue 3.
Pages 186-190 (March 2012)
Skill and talent
Nephroscopy with carbon dioxide in combination with laparoscopy in the treatment of urinary stones
Nefroscopia con uso de dióxido de carbono en combinación con laparoscopia para el manejo de la litiasis urinaria
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A. García-Seguí
Corresponding author
agarciasegui@gmail.com

Corresponding author.
, M. Gascón-Mir
Servicio de Urología, Hospital General Mateu Orfila, Mahón, Menorca, Islas Baleares, Spain
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Abstract
Objective

Laparoscopy in combination with nephroscopy is rarely used for the treatment of complex urinary stones or anatomical abnormalities with difficult access to stones. During the nephroscopy, in an opened renal pelvis, large amount of fluid leaks and collects in the peritoneal cavity and can be a drawback. In these cases, the nephroscopy with use of carbon dioxide (CO2) can be an alternative. We present our experience in with this technique.

Material and method

We performed surgeries using the 3-port transperitoneal technique. Five patients with urolithiasis were included. Three patients had concomitant ureteropelvic junction (UPJ) stenosis, one with stones in ectopic kidney, and the third had a large stone impacted in the proximal ureter. Patients were treated by pyelolithotomy or ureterolithotomy combined with flexible nephroscopy using CO2 and dismembered pyeloplasty was performed in appropriate cases. A flexible cystoscope was passed through a port and guided laparascopically through the opening in the renal pelvis. The gas cannula was connected to the irrigation channel of the endoscope to insufflate CO2 and calculi were extracted with a nitinol basket.

Results

Median age was 45 years (24–58). Mean operative time of nephroscopy was 22.4minutes (range 15–48). Mean intra-operative blood loss was inestimable. There were no complications or conversion. Residual lithiasis requiring ureteroscopy was present in one patient.

Conclusions

Flexible nephroscopy using CO2 in combination with laparoscopy is a feasible and effective technique for the treatment of urinary stones in selected cases to avoid accumulation of fluid in the peritoneal cavity.

Keywords:
Kidney
Laparoscopy
Nephroscopy
Calculi
Pyelolithotomy
Resumen
Objetivos

La laparoscopia en combinación con nefroscopia se ha usado en raras ocasiones para el tratamiento de litiasis urinarias complejas o con anomalías anatómicas que presentan cálculos de difícil acceso. Con la pelvis renal abierta, la fuga del líquido de irrigación hacia cavidad peritoneal puede ser inconveniente. La nefroscopia empleando dióxido de carbono (CO2) es una alternativa en estos casos. Nuestro objetivo es presentar nuestra experiencia con dicha técnica.

Material y métodos

Empleamos abordaje transperitoneal con tres trócares. Cinco pacientes con litiasis urinaria fueron incluidos. Tres casos presentaban estenosis de la unión pielo-ureteral, un caso tenía riñón pélvico y un último caso tenía un cálculo grande impactado en el uréter proximal. Se les realizó pielolitotomía o ureterolitotomía laparoscópica en combinación con nefroscopia flexible empleando CO2 y pieloplastia laparoscópica en los casos correspondientes. Se insertó un cistoscopio flexible a través de un trócar y se dirigió hasta las cavidades renales. La manguera del gas se conectó al canal de irrigación del endoscopio para insuflar el CO2 y se realizó la extracción de los cálculos con cesta.

Resultados

La edad promedio de los pacientes fue 45 años (24-58). El tiempo operatorio pro-medio de la nefroscopia fue 22,4 minutos (15-48) y el sangrado intraoperatorio fue inestimable. No se presentaron complicaciones ni conversión. Un paciente presentó litiasis renal residual que precisó ureteroscopia.

Conclusiones

La nefroscopia flexible empleando CO2 en combinación de laparoscopia es fac-tible y efectiva para el tratamiento de la litiasis urinaria en casos seleccionados, ya que evita la acumulación de líquido en la cavidad peritoneal.

Palabras clave:
Riñón
Laparoscopia
Nefroscopia
Cálculos
Pielolitotomía

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