Simultaneous bilateral endoscopic surgery for kidney stones successfully conducted on a 56-year-old woman
Simultaneous Bilateral Endoscopic Surgery (SBES) requires lesser anesthesia time and shorter operative time, which reduces possibility of adverse events as well as cost of treatment and time spent in the hospital.
Kidney stones are a common problem which can lead to urinary problems, infections, and kidney damage, if left untreated. A 56-year-old woman with bilateral kidney stones successfully underwent Simultaneous Bilateral Endoscopic Surgery (SBES) at Fortis Hospital, Cunningham Road. She was in immediate need of surgical treatment for her kidney stones as the stone in the renal pelvis was of large size and was causing obstruction, swelling and severe pain to her. Any stone which blocks urine flow by obstructing the kidney or ureter (tube which allows urine to pass from the kidney to the bladder) can cause significant pain and it needs to be cleared at the earliest. Thus, Simultaneous Bilateral Endoscopic Surgery (SBES) was considered for the woman to reduce the time of surgery. It is a new technique for the treatment of bilateral kidney stones that involves two surgeons operating in tandem to complete the procedure in a much shorter duration.
SBES successfully conducted at Fortis Hospital
A team of doctors led by Dr Shakir Tabrez - Senior Consultant - Urology, Uro-oncology, Andrology, Transplant & Robotic Surgery, and Dr Mohan BA Consultant- Urology & Transplant Surgery, Fortis Hospital, Cunningham Road, successfully conducted Simultaneous Bilateral Endoscopic Surgery (SBES) on a woman who had bilateral large kidney stones. They used a procedure called Retrograde Intra Renal Surgery (RIRS) to clear the stone in the right renal pelvis while the stone in the left kidney was removed using a procedure termed as Percutaneous Nephrolithotripsy (PCNL).
In cases when the stones are on either side, conventionally a urologist would do the procedure on one side by clearing the stone completely and then focus his attention on the second stone on the other side. This would require the patient to be under anaesthesia for a longer duration than necessary and this increases the possibility of adverse events, especially if the patient is elderly and has comorbid factors, like heart disease, hypertension, diabetes etc. By reducing the time of surgery, Simultaneous Bilateral Endoscopic Surgery helps prevent these adverse events.
This is how Simultaneous Bilateral Endoscopic Surgery is done
In Simultaneous Bilateral Endoscopic Surgery (SBES), one doctor focused on the right renal pelvic stone through a flexible ureteroscope and laser and completely powdered the stone and passed a stent. Another surgeon simultaneously did a Supine PCNL on the stone in the left kidney where the scope is passed directly into the kidney through a very small incision and cleared the stone completely. This procedure helped cut down the time of surgery which also reduced the use of anaesthesia in this case - Dr Tabrez elaborated.
Dr. Mohan added, "Conventionally PCNL is done with the patient in the prone position (lying with their chest down). But our team has been offering Supine PCNL for almost all our patients barring exceptions - where the patient lies on his/her back - thus allowing for lesser complications and paving the way for us to do the SBES procedure. The patient had a pain free post-operative period and was discharged the next day."
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According to the surgeons, the advantage of this SBES procedure is the reduced operating time which is advantageous to the patient in terms of reducing possibility of adverse events and reduces the time spent in the theatre which by extension would reduce cost of the surgery. But this procedure requires advanced equipment including multiple endoscopes, cameras and most importantly two competent urologists who can operate on both sides of a patient without hampering the other.
It is a safe and effective treatment with lesser anaesthesia time, shorter operative time, reduced cost of treatment and lesser time spent in the hospital with minimal morbidity. Any possible complications can be avoided, and the operation can be carried out smoothly as long as the surgeons work cohesively and are experienced with presence of advanced equipment in the operating room they added.