The surgical management of urolithiasis has undergone a remarkable clinical evolution over the past three decades. The once common practice of open stone surgery has nearly been relegated to historical interest by modern technology. The introduction of minimally invasive techniques, laparoscopy and robot-assisted surgery, have emerged to complete the urologist’s armamentarium. The benefits to patients when other endourologic procedures have failed include less pain, shorter hospitalization and convalescence, and improved cosmesis. This chapter explores the historical shift from open to minimally invasive management for stone disease and the unique risks and outcomes associated with these procedures in modern urology.
Key points
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The prevalence of open surgical procedures has decreased dramatically with the advent of minimally invasive and endourologic procedures in the United States and world wide.
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When endourologic procedures fail, laparoscopic or robot-assisted techniques offer patients significant benefits over open surgery.
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In certain clinical circumstances such as abnormal anatomy, the need for concomitant reconstruction efforts, the unavailability of endoscopic equipment or experience, robotic or laparoscopic approaches may be considered as initial treatment options for patients.
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