Lower ureteral stones revisited: Expanding the horizons of robotics

Objective: To study the feasibility of robot-assisted laparoscopic ureterolithotomy for large (>2 cm) or impacted lower ureteral stones and the immediate outcome measures such as the stone-free rate and occurrence of intra- and postoperative complications. Materials and Methods: From April 2010 to August 2012, 52 robotic stone surgeries were performed in our department. Robot-assisted laparoscopic ureterolithotomy was performed in 16 patients for large (>2 cm) or impacted lower ureteral stones. Results: The stone was most commonly located in the juxtavesical position in all 16 patients. The average stone size was 2.2 cm, and all stones were impacted. The mean operative time was 45.3 minutes (range, 38-63), including stent placement time, and the mean blood loss was 10 mL. The mean console time was 20.3 minutes. No conversion to an open procedure was required. Conclusion: Robot-assisted laparoscopic ureterolithotomy for large, impacted, lower ureteral stones is an acceptable alternative. The ease of surgery and shorter operative times are significant advantages compared with the laparoscopic approach.