title: Laparoscopy-assisted transperitoneal percutaneous nephrolithotomy for renal caliceal diverticular calculi.
abstract: OBJECTIVE
  There are a variety of options for the management of symptomatic calculi in caliceal diverticula, each with utility in particular situations. Herein, we describe a laparoscopy-assisted transperitoneal percutaneous nephrolithotomy (PCNL) technique to address the unusual combination of an anterior caliceal diverticulum together with multiple branched calculi having segments both within and proximal to the diverticulum.
  
  
  METHODS
  With the patient in a modified lithotomy position, standard transperitoneal laparoscopy was performed utilizing three 10-mm trocars. After mobilization of the colon medially, the cystic diverticulum was opened. An additional 12-mm trocar was placed to allow transperitoneal PCNL within the diverticulum. Rigid nephroscopy, holmium laser lithotripsy, and stone extraction were performed, including laser enlargement of the diverticular neck and removal of the stone burden proximal to the neck. A double-pigtail ureteral stent and Jackson-Pratt drain were placed.
  
  
  RESULTS
  This procedure was successful in the only patient in whom it has been used to date. As far as we know, this is the first report of laparoscopy-assisted transperitoneal PCNL for the management of caliceal diverticular calculi.
  
  
  CONCLUSIONS
  Laparoscopy-assisted transperitoneal PCNL is a safe and effective alternative for the management of symptomatic stones in anterior cystic caliceal diverticula with a narrow neck and complex branched calculi.
authors.affiliation: Department of Urology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma 73104, USA. carson-wong@ouhsc.edu
authors.forename: Carson
authors.initials: C
authors.lastname: Wong
authors.forename: Robert A
authors.initials: RA
authors.lastname: Zimmerman
mesh_terms: D004240:Diverticulum / Q000000981:diagnostic imaging / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007669:Kidney Calculi / Q000000981:diagnostic imaging / Q000628:therapy*; D007670:Kidney Calices / Q000000981:diagnostic imaging / Q000473:pathology*; D010535:Laparoscopy / Q000379:methods; D008875:Middle Aged; D009403:Nephrostomy, Percutaneous / Q000379:methods*; D018570:Risk Assessment; D012720:Severity of Illness Index; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome