Endourology & Stone Disease(비디오) (V-010) Robot assisted laparoscopic pyelolithotomy for huge staghorn stone Department of Urology, Kyung Hee University, School of Medicine Dong Soo Kim, Jeonghyouk Choi, Taesoo Choi, Koo Han Yoo, Seung Hyun Jeon, Sun-Ju Lee, Choong Hyun Lee, Sung-Goo Chang, Sang Hyub Lee, Introduction Treatment of large staghorn renal stones is challenging, especially if the patient is at high risk of intra-operative bleeding. We report a case of a staghorn stone treated by robot assisted laparoscopic pyelolithotomy. Case Report A 67 male with a history of hypertension, unstable angina, and multiple sessions of percutaenous interventions was referred to the department of urology for evaluation of gross hematuria. He had been admitted to the department of general surgery for treatment of superior mesenteric vein thrombophlebitis and had undergone heparinization. Evaluation showed a huge left staghorn stone on his CT scan. Due to his medical conditions and medication, an endoscopic approach was considered dangerous and robot assisted laparosopic pyelolithomy was carried for stone removal. The robot assisted laparoscopic approach allowed us to approcah the stone without penetrating the renal parenchyma and which prevented excessive intra-operative bleeding. We were able to remove most of the stone in one session and reduced the need for the patient to go under general anesthesia multiple times for repeated endoscopic treatment. Due to the stone size however, we were not able to remove the stone in one piece. A lithoclast device, inserted through the assistant port was used to break the stone, and the fragments were collected in a specimen bat to be removed later. The patient was discharged after recovery from surgery and no major complications were observed. At follow up, the patient only showed gross hematuria and was otherwise healthy. In conclusion robot assisted laparoscopic pyelolithotomy is a feasible method of stone removal with little complications and should strongly be considered in patients at high risk of intra-operive bleeding. keywords : Staghorn stone, robotic surgery