[23] Utilising the da Vinci® robotic surgical system to treat challenging urinary stones: West Virginia University experience

Objective: To report our experience in utilising the Da Vinci® robotic surgical (Intuitive Surgical Inc., Sunnyvale, CA, USA) system to treat patients with challenging urinary stones (CUS). Methods: We reviewed our prospectively collected data of patients who underwent robot-assisted stone surgery (RASS). We utilised the da Vinci to treat 21 patients with CUS at our institute. A CUS was defined as a stone that could not be treated or had failed attempts at treatment with traditional minimally invasive surgery such as extracorporeal shockwave lithotripsy, ureteroscopy, or percutaneous nephrolithotomy (PCNL). Results: In all, 19 patients had RASS at our institute. The indications for robot-assisted laparoscopic pyeloplasty were: morbid obesity (eight patients, mean body mass index 56.4 kg/m2), need for concurrent renal surgery (five), severe contractures limiting positioning for retrograde endoscopic or percutaneous nephrolithotripsy (two), symptomatic calyceal diverticular stone with failed endoscopic approach (four), and after failed PCNL (two). Patients had an average of 2.3 stones and total stone volume of 16.5 mL measured by computed tomography (CT). The mean (range) blood loss was 57.8 (25–300) mL. The mean (range) operative time was 110 (50–180) min, with a mean (range) hospital stay of 2.5 (1–8) days. The mean follow-up was 54 days and 91% of patients were stone free on the follow-up CT. Four patients (4%) developed complications: one patient (5%) developed candidaemia, one patient (5%) developed urine leakage that necessitated prolonged stenting and catheterisation, and two patients (9%) developed wound infections. Conclusion: The treatment of urological stones can be challenging, RASS is a promising way to remove kidney stones with high stone-free rates. RASS should be considered as an option to replace open stone surgery