Open surgery: Current status and techniques

Abstract

The introduction and widespread use of minimally invasive techniques such as extracorporeal shock wave lithotripsy (ESWL), percutaneous nephrolithotomy (PCNL), ureteroscopy (URS), and retrograde intrarenal surgery (RIRS) using fi ne fi ber-optic scopes have drastically reduced the need and indications for open surgery for renal and ureteric stones. However, in a small minority of cases such as those with large and complex staghorn stones that are not amenable for minimally invasive surgery or in some of those with recurrent stone disease, open surgery is still required. Since open surgery is rarely performed, the issue of training is important and needs to be addressed. Although in the not-too-distant future, if as it seems likely that the laparoscopic approach will take over the need for conventional open operations, centralization of complex stone surgery will become inevitable in the future.