Laparoscopic management of caliceal diverticular calculi

PURPOSE: We describe laparoscopic techniques for the definitive management of symptomatic caliceal diverticular stone disease. MATERIALS AND METHODS: Five patients underwent retroperitoneoscopic management of a symptomatic, stone bearing caliceal diverticulum. Techniques for intraoperative localization of the stone bearing diverticulum included retrograde injection of indigo carmine, fluoroscopy and/or laparoscopic ultrasound. In 2 cases the patent neck of the diverticulum was sutured via laparoscopy. RESULTS: Complete stone clearance and obliteration of the diverticular cavity was achieved in all cases without any open conversion. Mean operative time was 133.8 minutes. Mean estimated blood loss was less than 50 cc in 4 cases and 150 cc in 1. Mean hospital stay was 36 hours. There were no laparoscopic or postoperative complications. CONCLUSIONS: The laparoscopic approach to symptomatic caliceal diverticula represents an effective and minimally invasive modality for complete clearance of the stone burden and definitive management of the anatomical abnormality. However, patient selection is paramount. We reserve the laparoscopic approach for symptomatic caliceal diverticula with thin overlying renal parenchyma, or for anterior lesions inaccessible to or unsuccessfully managed by endourological techniques. A decision tree algorithm for managing symptomatic caliceal diverticular calculi is proposed.