Authors: René Sotelo, Rafael Clavijo, Robert De Andrade, Oswaldo Carmona, Roy López, Eduardo Banda, Golena Fernández, Camilo Guidelman
Technique: Laparoscopic Anatrophic Nephrolithotomy for Complex Staghorn Calculi with early unclamping and controlled hypotension: The is dissected, the artery and vein are isolated. The vain and the artery are controlled with bulldog clamps. An incision is made with a laparoscopic knife in the avascular plane along Brodel's line. The stone is extracted. The large vessels that are visualized are oversewn individually. Controlled hypotension is applied minutes prior to hilium release. The bulldog clamps are removed from both the artery and vein within 20 minutes. Any additional bleeding are identified and oversewn. With the cooperation of the anesthesiologist, the mean blood pressure is gradually raised.
Advantages: Diminishes ischemia time Ensure hemostasis prior the kidney closure Decreases the risk for arteriovenous fistula or aneurysm formation.
Results: Preserved Renal Parenchyma and function. Excellent hemostasis and early unclamping. Controlled hypotension to reduce ischemia time. 6.6% decrease in renal function after laparoscopic anatrophic nephrolithotomy compared to patients undergoing complex PNL with 8% decrease in renal function.
Conclusion: Our goal, besides removing the stone, is to preserve renal parenchyma and function. The technique has evolved achieving excellent hemostasis with an accurate incision along Brodel's avascular line and early unclamping, preferably 20 minutes along with controlled hypotension to reduce ischemia time. Patients undergoing complex PNL have demonstrated an 8% decreased in renal function, compared with the present study, which reports a 6.6 decreased in renal function after Laparoscopic Anatrophic Nephrolythotomy.