Laparoscopic Kidney Stone Surgery

Laparoscopic kidney stone surgery is a minimally invasive procedure used to treat stones in the kidneys that cannot pass on their own or cause various complications. This method is performed through smaller incisions compared to traditional open surgery, significantly reducing the patient’s recovery time. Laparoscopic kidney stone surgery aims to maximize patient comfort and safety while taking full advantage of modern medical advancements.

Kidney stone surgery is performed to treat stones in the kidneys that are too large to pass on their own or cause various complications. The necessity of surgery depends on the stone’s size, location, symptoms, and the patient’s overall health. The main reasons for performing kidney stone surgery include:

• Severe Pain: Surgery may be required if the stone causes intense pain (renal colic) while moving through the urinary tract.
• Obstruction: Stones can block urine flow, impair kidney function, and require surgery to relieve the obstruction.
• Infection: Stones may cause urinary tract infections or worsen existing infections. Recurrent infections can indicate the need for surgery.
• Kidney Damage: Prolonged obstruction or infection can lead to kidney damage, which surgery can help prevent.
• Large Stones: Stones too large to pass naturally (usually over 6 mm) need to be surgically removed.
• Failure of Other Treatments: Surgery may be necessary if other treatments, such as ESWL (extracorporeal shock wave lithotripsy) or ureteroscopy, fail.
• Bleeding: Stones causing bleeding in the urinary tract may also require surgical intervention.

Kidney stone surgery aims to relieve pain, prevent infections, protect kidney function, and improve the patient’s quality of life.

The method used for kidney stone surgery depends on the size and location of the stone as well as the patient’s overall condition. Below are the most common techniques used in the treatment of kidney stones:

Extracorporeal Shock Wave Lithotripsy (ESWL)

• In this method, high-energy shock waves are directed from outside the body to break kidney stones into smaller fragments.
• The fragmented stones are then passed naturally through the urinary tract.
• It is generally preferred for stones smaller than 2 cm.
• It is not a surgical operation but a non-invasive procedure.
• Usually does not require anesthesia or may be performed under mild sedation.

Ureteroscopy (URS)

• A thin tube called a ureteroscope is inserted through the urinary tract into the bladder and ureter (the tube connecting the kidney to the bladder) to reach the stone.
• The stone is then broken up and removed using a laser or other specialized tools.
• It can be used for both kidney and ureteral stones.
• Typically performed under general anesthesia.

Percutaneous Nephrolithotomy (PCNL)

• A small incision is made in the back to insert a tube directly into the kidney.
• Under ultrasound or X-ray guidance, the stone is visualized and broken into pieces with a laser or other instruments, then removed.
• Preferred for large or complex stones.
• Usually performed under general anesthesia.

Laparoscopic or Robotic Surgery

• Small incisions are made in the abdomen to insert a laparoscope (camera) and surgical instruments.
• The stone is visualized and removed under direct imaging guidance.
• Used in rare and specific cases.
• Performed under general anesthesia.

Open Surgery

• A large incision is made in the abdomen or side to reach and remove the stone directly from the kidney.
• Rarely used today and typically reserved for cases where other methods are unsuitable.
• Performed under general anesthesia.

Laparoscopic kidney stone surgery is a minimally invasive procedure used to treat stones in the kidneys. Compared to traditional open surgery, it involves smaller incisions, offering several advantages for patients.

The procedure is performed as follows:

• Anesthesia:
  • The surgery is usually performed under general anesthesia.
• Incisions:
  • Several small incisions (0.5–1 cm) are made in the abdominal area.
• Insertion of Laparoscope and Instruments:
  • A laparoscope (camera) is inserted through one of the incisions.
  • Specialized surgical instruments are inserted through the other incisions.
• Inflation of the Abdominal Cavity:
  • The abdominal cavity is inflated with carbon dioxide gas to create a working space for the surgeon and improve visualization of organs.
• Accessing and Breaking the Stone:
  • Under camera guidance, the kidney is reached.
  • The stone is fragmented using tools such as a laser or ultrasound.
• Removal of Stone Fragments:
  • The broken stone pieces are removed from the abdomen using small instruments.
• Placement of a Stent if Needed:
  • A temporary stent (DJ stent) may be placed to ensure urine flow.
• Closure of Incisions:
  • Incisions are closed with sutures or surgical adhesive.

Advantages of Laparoscopic Kidney Stone Surgery:

• Less pain and bleeding due to smaller incisions
• Shorter hospital stay
• Faster recovery and return to normal activities
• Minimal scarring

The risks of kidney stone surgery vary depending on the size and location of the stone as well as the surgical method used.

Common Risks (All Surgery Types):

• Infection: May occur at the surgical site or in the urinary tract.
• Bleeding: Can occur during or after surgery.
• Pain: Postoperative pain is normal but can be severe in some patients.
• Anesthesia Complications: Rarely, allergic reactions or respiratory issues may occur.
• Injury to Nearby Organs: Adjacent organs such as the intestines, spleen, or other internal organs may be injured.

Specific Risks (Depending on Surgery Type):

• ESWL (Extracorporeal Shock Wave Lithotripsy):
  • Bleeding in or around the kidneys
  • Stone fragments blocking the urinary tract (stone street)
  • Kidney damage
• Ureteroscopy (URS):
  • Injury to the ureter (tube between kidney and bladder)
  • Infection
  • Bleeding
  • Incomplete removal of stones
• Percutaneous Nephrolithotomy (PCNL):
  • Bleeding (may require blood transfusion in some cases)
  • Infection
  • Air accumulation between the lung membranes (pneumothorax)
  • Kidney damage
  • Injury to nearby organs
• Laparoscopic/Robotic Surgery:
  • Risks related to general anesthesia
  • Internal bleeding in the abdomen
  • Infection
  • Bowel injuries
  • Urinary tract injury
• Open Surgery:
  • Infection
  • Bleeding
  • Wound healing problems
  • Long-term pain