Simultaneous Bilateral Endoscopic Surgery

A 56-year-old female underwent Simultaneous Bilateral Endoscopic Surgery (SBES) to clear two stones, one in her kidney and the second in the ureter. The stones were large in size with the one in the ureter causing obstruction, swelling, and severe pain to the patient. Any stone which obstructs the ureter, which is the tube that allows urine to pass from the kidney to the bladder, can cause significant pain and needs to be cleared at the earliest.

The stone in the right ureter needed a procedure called Ureterorenosopy (URS) And the stone in the left kidney needed a procedure termed Percutaneous Nephrolithotripsy (PCNL).

Now, since the stones were on either side conventionally a urologist would do the procedure on one side - clear the stone completely and then focus his attention on the other side. This requires the patient to be under anesthesia for a longer duration than necessary which can increase the possibility of adverse events, especially if the patient is elderly and has comorbid factors, like heart disease, hypertension, diabetes, etc. It is also time-consuming and causes fatigue for the operating surgeon.

In Simultaneous Bilateral Endoscopic Surgery (SBES), one urologist of our team focused on the right ureteric stone through a 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.

Again, conventionally PCNL is done with the patient in the prone position (on his/her stomach). But our team has been offering Supine PCNL for almost all our patients batting 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.

The advantage of this SBES procedure is the reduced operating time which is advantageous to the patient in terms of reducing the possibility of adverse events and also reduces the time spent in the theatre which by extension would reduce the 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 anesthesia 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 carried out smoothly as long as the surgeons work cohesively and are experienced with the presence of advanced equipment in the operating room.

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