title: Laparoscopic pyelolithotomy: An emerging tool for complex staghorn nephrolithiasis in high-risk patients.
abstract: OBJECTIVE
  To evaluate the effectiveness of laparoscopic pyelolithotomy (LP) for staghorn stones (>3-4 cm) in patients with chronic liver disease or coronary artery disease.
  
  
  METHODS
  In all, 49 patients underwent LP; they were divided into four groups, with stones in group 1 in the renal pelvis only, in group 2 in the renal pelvis and one calyx, in group 3 in the renal pelvis and two calyces, and in group 4, in the renal pelvis and more than two calyces. Patient demography, stone characteristics, surgical outcomes and complications were evaluated.
  
  
  RESULTS
  The mean stone-free rate in one session was 90% among all groups. The mean (SD) stone size was 4.27 (1.72) cm. The stone-free rate decreased with greater stone burden, but the operative time, estimated blood loss and need for ancillary procedures increased with stone burden. No blood transfusion was required and one patient each in groups 2 and 4 had a urine leak.
  
  
  CONCLUSIONS
  LP provides acceptable results in complex cases for managing renal stone disease with a larger stone burden in high-risk situations.
authors.affiliation: Department of Urology and Renal Transplantation, Amrita Institute of Medical Sciences, Kochi, Kerala, India.
authors.forename: Himesh Ramesh
authors.initials: HR
authors.lastname: Gandhi
authors.affiliation: Department of Urology and Renal Transplantation, Amrita Institute of Medical Sciences, Kochi, Kerala, India.
authors.forename: Appu
authors.initials: A
authors.lastname: Thomas
authors.affiliation: Department of Urology and Renal Transplantation, Amrita Institute of Medical Sciences, Kochi, Kerala, India.
authors.forename: Balagopal
authors.initials: B
authors.lastname: Nair
authors.affiliation: Department of Urology and Renal Transplantation, Amrita Institute of Medical Sciences, Kochi, Kerala, India.
authors.forename: Ginilkumar
authors.initials: G
authors.lastname: Pooleri
keywords: CAD, coronary artery disease; CLD, chronic liver disease; EBL, estimated blood loss; High-risk patients; LP, laparoscopic pyelolithotomy; Laparoscopic pyelolithotomy; NCCT, noncontrast CT; PNL, percutaneous nephrolithotomy; SFR, stone-free rate; Staghorn nephrolithiasis; Stone-free rates; URS, ureterorenoscopy