Laparoscopic pyelolithotomy with intraperitoneal ultrasonic lithotripsy: report of a novel minimally invasive technique for intracorporeal stone ablation.

We present the case of a 71-year-old Hispanic woman with a 4-cm stone in the renal pelvis of a kidney with thin parenchyma. Retrograde pyelography revealed a normal ureter and normal ureteropelvic junction. A ureteral stent was placed. Six weeks after the stent was placed, a differential renal scan revealed 18% function of the involved kidney. A percutaneous nephrolithotomy was not performed because of the thin parenchyma and intrarenal anatomy, which would have complicated access. The patient underwent an uncomplicated laparoscopic pyelolithotomy. The stone was placed into an Endocatch entrapment sack. The open end of the Endocatch sack was brought through a trocar site, and a nephroscope and ultrasonic lithotripter were deployed. The stone was fragmented and aspirated in the standard manner, thereby avoiding the need to extend the 12-mm trocar incision for stone extraction. The stone fragmentation and extraction time was 14 minutes. The patient was stone-free and discharged home in the morning of the first postoperative day without complications.