Urology Video Journal (Dec 2020)
A novel approach for removal of a retained calcified ureteral stent using a single robotic procedure
Abstract
Objective: To describe a unique approach for removal of a retained calcified ureteral stent of 4 years, originally placed at another institution, via a combined robotic assisted laparoscopic pyelolithotomy and cystolithotomy. Materials and Methods: Utilizing the Da Vinci Xi platform, four 8 mm ports were placed in the left mid-clavicular line, and a 12 mm midline assistant port at the umbilicus. The platform's multi-quadrant ability and port-hopping feature allowed us to perform this with a single procedure. Following opening of the renal pelvis, the encrusted stent and stones were removed. The distal end of the stent had already been detached from the bladder stone and was removed via the pyelotomy. A ureteral stent was placed in an antegrade fashion. The renal pelvis was closed in a running fashion, with Gerotas fascia re-approximated over the closure. We then performed a standard cystotomy with removal of the calcified distal stent and closed the bladder in a standard 2-layer fashion. A Jaxon-Pratt drain was placed in the left retroperitoneal space. The proximal stent portion and the bladder stone were placed in to separate specimen bags, which were extracted through the periumbilical assistant trocar by extending the incision 3.5 cm. Results: The robotic operative time was 125 min, the estimated blood loss was 100cc. The patient's post-op course was uneventful and the Jaxon-Pratt drain was removed on post-operative day 1 after obtaining a negative drain-fluid creatinine. She was discharged with oral antibiotics for 5 days. A Foley catheter was kept for 1 week and the ureteral stent was kept for 6 weeks. A renal ultrasound was obtained one month following stent removal which showed normal renal anatomy without evidence of hydronephrosis, a basic metabolic panel was also obtained which showed the patients renal function had remained normal. Stone analysis revealed a mixed struvite and calcium phosphate stone. Conclusion: This combined procedure has been reported in the pediatric population, via pure laparoscopy. The Da Vinci Xi platform with multi-quadrant and port hopping ability, allows us to translate this renal and bladder procedure to the adult population. In the case of this encrusted stent, we were able to remove both portions utilizing a single procedure without the need for additional port placement, re-docking, or re-positioning of the patient which in some cases can compromise the airway and sterility, thus resulting in a safe and successful operation with minimal hospital stay and procedure time.
