何肇晏¹、林宜佳^1,2、朱懿柏¹、葉志胤¹、蔡德甫^1,2、葉忠信^1,2、莊光達^1,2、鄭以弘¹、仇光宇^1,2、陳宏恩¹、吳子翔¹、黃一勝^1,2

1.新光吳火獅紀念醫院外科部泌尿科

2.輔仁大學醫學系

Chao-Yen Ho¹, Yi-Chia Lin^1,2, Yi-Bo Chu¹, Chih-Yin Yeh¹, Te-Fu Tsai^1,2, Chung-Hsin Yeh^1,2, Guang-Dar Juang^1,2, Yi-Hong Cheng¹, Kuang-Yu Chou^1,2, Hung-En Chen¹, Tzu-Hsiang Wu¹, Thomas I.S. Hwang^1,2

1.Division of Urology, Department of Surgery, Shin Kong WHS Memorial Hospital, Taipei

2.School of Medicine, Fu-Jen Catholic university, New Taipei City

 

Abstract: Calyceal diverticula are rare condition of the upper collecting system that likely have a congenital origin. Stones can be found in up to 50% of calyceal diverticula. Standard treatment modalities of caliceal diverticular calculi range from extracorporal shockwave lithotripsy (SWL) over retrograde intrarenal surgery (RIRS), percutaneous nephrolithotomy (PNL) and laparoscopic stone removal. Shock wave lithotripsy (SWL) is an option for first-line therapy in patients with stone-bearing diverticula with the lowest stone free rate. RIRS and ureteroscopy (URS) is best suited for management of anteriorly located mid- to upper pole diverticular stones. Drawbacks to URS include difficulty in identifying the ostium and low rate of obliteration. PNL is best used in posteriorly located mid- to lower-pole stones, but carries the risk of pulmonary complications. Laparoscopic surgery provides definitive management, but should be reserved for cases with large stones in anteriorly located diverticula with thin overlying parenchyma. Here we present a 57-year-old woman presented with multiple calyceal diverticular stones managed by a robot-assisted laparoscopic calycotomy with extraction of the calculi. The follow up of this patient reported no specific perioperative problems and good stone-free results. This article shows technical feasibility with minimal morbidity of robot-assisted laparoscopic stone removal.