title: Robotic nephrolithotomy and pyelolithotomy with utilization of the robotic ultrasound probe.
abstract: BACKGROUND
  The treatment of large renal stones in children can be challenging often requiring combination therapy and multiple procedures. The purpose of this video is to describe our technique of robotic nephrolithotomy and pyelolithotomy for complex renal stone disease in children, and to demonstrate the utility of the robotic ultrasound probe to aid with stone localization.
  
  
  METHODS
  Robotic nephrolithotomy/pyelolithotomy was carried out in four consecutive patients. A robotic ultrasound probe (Hitachi-Aloka, Tokyo, Japan) under console surgeon control was used in all cases.
  
  
  RESULTS
  Two patients underwent robotic pyelolithotomy, one patient underwent robotic nephrolithotomy, whilst the fourth patient underwent robotic pyelolithotomy and nephrolithotomy along with Y-V pyeloplasty for concurrent ureteropelvic junction obstruction. Mean operative time, blood loss and hospital stay was 216 minutes, 37.5 mL and 2 days, respectively. The robotic ultrasound probe aided identification of calculi within the kidney in all cases. For nephroli¬thotomy it was helpful in planning the incision for nephrotomy. After nephrotomy or pyelotomy, stones were removed using a combination of robotic Maryland forceps, fenestrated grasper or Prograsp. Antegrade nephroscopy introduced through a laparoscopic port was used in all patients for confirmation of residual stone status. Two patients did not require a ureteral stent in the post-operative period. One patient had a minor complication (Clavien Grade 2 - dislodged malecot catheter). All patients were stone free at last follow-up.
  
  
  CONCLUSIONS
  Robotic nephrolithotomy and pyelolithotomy with utilization of the robotic ultrasound probe offers a one-stop solution for complex renal stones with excellent stone-free rates.
authors.affiliation: Vattikuti Urology Institute, Henry Ford Health System (KRG, QDT, WJ, AF, MM, JSE), Detroit, MI, USA.
authors.forename: Khurshid R
authors.initials: KR
authors.lastname: Ghani
authors.affiliation: Vattikuti Urology Institute, Henry Ford Health System, Detroit, MI, USA.
authors.forename: Quoc-Dien
authors.initials: QD
authors.lastname: Trinh
authors.affiliation: Vattikuti Urology Institute, Henry Ford Health System, Detroit, MI, USA.
authors.forename: Wooju
authors.initials: W
authors.lastname: Jeong
authors.affiliation: Vattikuti Urology Institute, Henry Ford Health System, Detroit, MI, USA.
authors.forename: Ariella
authors.initials: A
authors.lastname: Friedman
authors.affiliation: Department of Pediatric Urology, Children's Hospital of Michigan, Detroit, MI, USA.
authors.forename: Yegapan
authors.initials: Y
authors.lastname: Lakshmanan
authors.affiliation: Vattikuti Urology Institute, Henry Ford Health System, Detroit, MI, USA.
authors.forename: Mani
authors.initials: M
authors.lastname: Omenon
authors.affiliation: Vattikuti Urology Institute, Henry Ford Health System and Department of Pediatric Urology, Children's Hospital of Michigan, Detroit, MI, USA.
authors.forename: Jack S
authors.initials: JS
authors.lastname: Elder
mesh_terms: D000293:Adolescent; D005260:Female; D006801:Humans; D007669:Kidney Calculi / Q000601:surgery*; D007682:Kidney Pelvis / Q000601:surgery; D010535:Laparoscopy / Q000295:instrumentation / Q000379:methods*; D009403:Nephrostomy, Percutaneous / Q000295:instrumentation / Q000379:methods*; D061646:Operative Time; D015203:Reproducibility of Results; D012371:Robotics; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional / Q000295:instrumentation / Q000379:methods*