Laparoscopic laser lithotripsy inside the endocatch bag: An alternative technique for removal of large post lap pyelolithotomy calculi

Swiss LithoClast® Trilogy Lithotripter for Use in Robotic Pyelolithotomy

Introduction

The Boston Scientific Swiss LithoClast® Trilogy lithotripter was intended for use in percutaneous nephrolithotomy. We performed, to our knowledge, the first two robotic pyelolithotomies using the Trilogy lithotripter for intracorporeal lithotripsy.

Case Description

Two cases are presented involving a 65-year-old female with a complete left staghorn calculus and hydronephrosis secondary to a left ureteropelvic junction (UPJ) obstruction, and a 69-year-old male with a large left staghorn calculus and multiple large left sided simple renal cysts. In both cases, a robotic pyelolithotomy was scheduled for stone removal along with concurrent UPJ repair and cyst decortication respectively. Following pyeloplasty and cyst decortication respectively, and following stone visualization, the 2.4-mm Trilogy probe was inserted into the 12-mm assistant port and under direct visualization the stone was fragmented and removed using Trilogy's built-in mechanisms. Both patients were treated successfully without complications and were found to be stone-free on follow-up.

Conclusion

The Trilogy lithotripter may be an effective tool for stone management when introduced during robotic pyelolithotomy and provides additional optionality when manual extraction poses challenges.