title: Zero-fragment Nephrolithotomy: A Multi-center Evaluation of Robotic Pyelolithotomy and Nephrolithotomy for Treating Renal Stones.
abstract: Robotic pyelolithotomy (RPL) and robotic nephrolithotomy (RNL) may be utilized for treating kidney stones as an alternative to percutaneous nephrolithotomy or flexible ureteroscopy.
  
  
  
  To describe the techniques of RPL and RNL, and present multi-center outcome data for patients undergoing these procedures.
  
  
  
  This study was a retrospective analysis of 27 patients undergoing RPL and RNL at five tertiary academic institutions between 2008 and 2014.
  
  
  
  RPL and RNL without use of renal ischemia.
  
  
  
  We assessed stone clearance by visual assessment and postoperative imaging. We also examined other factors, including complications (Clavien grade), estimated blood loss, operative time, and length of stay.
  
  
  
  Twenty-seven patients underwent 28 procedures for a mean renal stone size of 2.74cm (standard deviation: 1.4, range: 0.8-5.8). The mean stone volume was 10.2cm3. RPL accounted for 26 of these procedures. RNL was performed in one patient, while another underwent combined RPL-RNL. Indications included failed previous endourological management (13), staghorn calculi (five), gas containing stone (one), calyceal diverticulum (one), complex urinary tract reconstruction (two), and patient preference (four). The mean patient age was 35.6 yr and mean body mass index was 25.5kg/m2. Mean operative time/console times were 182min and 128min, respectively. The mean estimated blood loss was 38ml. The mean length of stay was 1.7 d. There was no significant change in preoperative and postoperative serum creatinine levels. The overall complication rate was 18.5% (Clavien 1=3.7%; 2=7.4%; 3b=7.4%). The complete stone-free rate was 96%.
  
  
  
  RPL and RNL are safe and reasonable options for removing renal stones in select patients. In particular, RPL allows the removal of stones without transgressing the parenchyma, reducing potential bleeding and nephron loss.
  
  
  
  The robotic approach allows for complete removal of the renal stone without fragmentation, thereby maximizing chances for complete stone clearance in one procedure.
authors.affiliation: Department of Urology, University of Michigan, Ann Arbor, MI, USA.
authors.forename: Ryan
authors.initials: R
authors.lastname: Swearingen
authors.affiliation: Vattikuti Urology Institute, Henry Ford Health System, Detroit, MI, USA.
authors.forename: Akshay
authors.initials: A
authors.lastname: Sood
authors.affiliation: Department of Urology, Medical College of Georgia, Augusta, GA, USA.
authors.forename: Rabii
authors.initials: R
authors.lastname: Madi
authors.affiliation: Department of Urology, Medical College of Georgia, Augusta, GA, USA.
authors.forename: Zachary
authors.initials: Z
authors.lastname: Klaassen
authors.affiliation: Department of Urology, Mount Sinai Hospital, New York, NY, USA.
authors.forename: Ketan
authors.initials: K
authors.lastname: Badani
authors.affiliation: Vattikuti Urology Institute, Henry Ford Health System, Detroit, MI, USA.
authors.forename: Jack S
authors.initials: JS
authors.lastname: Elder
authors.affiliation: Department of Urology, Wake Forest Baptist Health, Winston-Salem, NC, USA.
authors.forename: Kyle
authors.initials: K
authors.lastname: Wood
authors.affiliation: Department of Urology, Wake Forest Baptist Health, Winston-Salem, NC, USA.
authors.forename: Ashok
authors.initials: A
authors.lastname: Hemal
authors.affiliation: Department of Urology, University of Michigan, Ann Arbor, MI, USA. Electronic address: kghani@med.umich.edu.
authors.forename: Khurshid R
authors.initials: KR
authors.lastname: Ghani
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007669:Kidney Calculi / Q000601:surgery*; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D000074642:Nephrolithotomy, Percutaneous; D012189:Retrospective Studies; D065287:Robotic Surgical Procedures / Q000379:methods*; D015607:Stents; D013520:Urologic Surgical Procedures / Q000379:methods*; D055815:Young Adult
keywords: Kidney stone; Nephrolithotomy; Pyelolithotomy; Robotics; Urolithiasis