Robot-assisted anatrophic nephrolithotomy: Description of technique and early results

Purpose: To assess the feasibility and report early outcomes of robot-assisted anatrophic nephrolithotomy (RAN) as a treatment modality for patients with complex staghorn calculi. Patients and Methods: In this single-center prospective study, seven consecutive patients underwent RAN for complex staghorn calculi. After dissection to the renal hilum and clamping of the renal vessels, a nephrotomy was made along the Brodel line and dissection carried through the collecting system to the calculus. The stone was extracted, and the collecting system and parenchyma were closed in layers; no cooling of the kidney was performed. Results: The mean patient age was 47±16 years, mean body mass index was 31.9±10.0 kg/m², and five of seven patients had complete staghorn calculi. Mean warm ischemia time was 35±7 minutes, mean robotic time was 158±51 minutes, and mean estimated blood loss was 121±39 mL. Mean length of stay was 3.0±1.7 days, and there was one perioperative complication. Five of seven patients had >90% reduction in stone burden, and two (29%) patients were completely stone free. Mean follow-up time was 5.1±4.3 months, and there was no decrease in postoperative estimated glomerular filtration rate compared with preoperative values. Conclusions: Our preliminary experience with RAN demonstrates a safe procedure with encouraging outcomes as a minimally invasive treatment modality for patients with extensive stone burden. Longer follow-up to determine the effect of RAN on renal function is needed.