56yr/Male

s/p Lt PCNL (2014.10.24) but remnant stones+

-> Therefore, Lt RIRS was planned for removal of remnant stones.

Preoperative CT (2016.3.20): Fragmentation of previously noted staghorn stones in the Lt kidney. Remained fragmented several calycesl stones in lower pole of Lt kidney (less than 1.6 x 1.1cm, more than number in 4). Remained diffuse dilatation and thickening of Lt renal pelvocalyx and entire ureter

Surgical Notes:

- Dilated ureter in CT scans and 12/14Fr ureteral access sheath was used.

- There were stones in Lt lower pole posterior calyx and Lt lower pole anterior calyx.

- Stones of Lt lower pole posterior calyx were completely removed by primary defection of fURS and dusting technique.

- Diverticular stones in the Lt lower pole anterior calyx, inaccessible by primary deflection of fURS

- Secondary deflection was used for access and the diverticular opening was incised by laser. Finally the stones were removed by dusting technique.

- Primary and secondary deflection can be controlled by Lt and Rt hands, respectively.