The role of open and laparoscopic stone surgery in the modern era of endourology

Treatment options for kidney stones and ureteral stones have evolved considerably over the past several decades, to the point where almost any stone can now be considered for treatment with a noninvasive or a minimally invasive approach including shock wave lithotripsy, ureteroscopy or percutaneous nephrolithotomy. The safety and morbidity associated with these techniques are favourable relative to traditional open surgical approaches to stone removal. However, they also require unique skillsets, access to instrumentation and relatively high maintenance costs, potentially limiting their use on a global scale. Coincident with the emergence of endourology have been considerable improvements in laparoscopic surgical techniques to the point that nearly any open surgery can be performed in a minimally invasive laparoscopic fashion. Such approaches, including those with robotic assistance, have potential application for the treatment of upper urinary tract stones, particularly in complex senarios as well as in areas where access to endourological instruments might be limited.