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Comparative Study of Surgical Approaches for Renal Pelvic Stones in a Northern Rural Medical College
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was significantly longer in group II (LPL) (1 ± 22.11 vs Table 5: Comparison in mean operative time in various studies
51.19 ± 24.39 minutes). They concluded PNL is the stan- Mean operative time for laparoscopic
dard treatment in most cases of renal pelvic stones; LPL Various studies procedure (min)
is another feasible surgical technique for patients with Yanev et al 10 88
large renal pelvic stones. Qadri et al 11 88
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Qin et al assessed a retroperitoneal laparoscopic tech- Leonardo et al 12 85
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nique for treatment of complex renal stones. Seventy-five Karami et al 14 82
patients, including 53 men and 22 women with a mean Nasseh et al 85.5
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age of 47.8 years, underwent retroperitoneal laparoscopy. Qin C et al 5 96
74.83
Patloo et al
They completed the procedure successfully in 73 cases, Present study 79 ± 16.90
while 2 cases were converted to open surgery. The opera-
tive time was 85 to 190 minutes with a mean of 96 minutes.
After the operation, seven patients experienced urinary and 9.8 (with SD of 4.3) respectively. It was found that
leakage. They concluded that the procedure is safe for pyelotomy closure time was more in group I as compared
sparing the nephron, less bleeding, short hospitalization, with group II, and time taken for DJ stent insertion was
and quick postoperative recovery. also more in group I as compared with group II.
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Agarwal compared the safety, efficacy, and outcomes
of LPL with PCNL for the management of a single large Estimated Blood Loss
(>2.0 cm) renal pelvic calculus. It included two groups: In a study conducted by Patloo et al to compare RLP with
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Group I included 18 patients treated by LPL and group II OP, the mean blood loss was less in the laparoscopic group
included 20 patients treated by PNL. The mean stone than in the open group (73 vs 103 mL). Qin et al found
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size in the LPL and PNL groups was 3.7 and 3.90 cm average estimated blood loss in their study to be 80 mL
respectively. There was one conversion to open surgery in a study of laparoscopic retroperitoneal management
in the LPL group. There was no residual stone and no of stone. Al-Hunayan et al found average blood loss of
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need of blood transfusion in the postoperative period in 57.2 mL in their study of patients who underwent RLP. In
both groups. They concluded that retroperitoneoscopic our study, estimated blood loss was found to be 40.7 mL
pyelolithotomy (RPPL) was associated with longer oper- (with SD of 20.9 mL) in group I and 100.4 mL (with SD
ating time, more invasive and less cosmetics; required of 12.35 mL) in group II, and this difference of estimated
more analgesia; and had more blood loss as compared blood was statistically significant. Blood transfusion was
with PNL. not required in any patient of group I, but required in two
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In a study conducted by Patloo et al to compare patients of open group (Table 6).
RLP with OP, mean operative time was significantly less Goel et al evaluated the role of RPPL for the man-
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(p < 0.001) in the open group than in the laparoscopic agement of renal pelvic calculus and its comparison with
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group (74.83 vs 94.43 minutes). In a study by Yanev et al, PCNL for solitary renal pelvic stone and found two conver-
mean operative time for laparoscopic surgery was sions – one because of stone slippage and the other because
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88 minutes. In Farooq Qadri et al’s study, mean operative of dense adhesions around the renal pelvis with conversion
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time for laparoscopic surgery was found to be 88 minutes. rate of 12.5%. Farooq Qadri et al found a conversion rate of
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Leonardo et al found that the mean operative time in 2.4%; three patients were converted due to dense adhesion
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laparoscopic surgery group patients was 85 minutes. around the ureter. Agarwal compared the safety, efficacy,
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Karami et al found mean operative time of 82 minutes and outcomes of laparoscopic pyelolithotomy (RPPL) with
for laparoscopic surgery. Mean operation time was PCNL for the management of single large renal pelvic cal-
85.48±15.11 minutes. Except for one stone migration and culus (>2.0 cm). There was one conversion to open surgery
one conversion to open surgery, all the ureteral stones in the RPPL group due to adhesions around the pelvis, and
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were extracted laparoscopically (94% success rate). In conversion rate was 5.55%. In the present study, 11 cases in
our study, the mean duration of surgery in group I was the laparoscopic arm had to be converted to the open tech-
79 minutes (with SD of 16.90) and in group II, it was nique. Conversion rate was 6.67% (11 cases out of 160 cases
61.83 minutes (with SD of 12.35). These results were statis-
tically significant with approximate (approx.) difference Table 6: Comparison of estimated blood loss in different studies
of 18 minutes (Table 5). Studies Blood loss (mL)
In group I, pyelotomy closure time and DJ insertion Qin C et al 15 80
time were 5.2 minutes (with SD of 4.3) and 9.8 (with SD Al Hunayan et al 16 57.2
of 4.3) respectively. In group II, pyelotomy closure time Patloo et al 5 73
and DJ insertion time were 5.2 minutes (with SD of 4.3) Present study 40.7 ± 20.9
World Journal of Laparoscopic Surgery, January-April 2017;10(1):1-7 5