This technique has been the oldest one in use for more than 30 years. Here nephrectomy incision is made on a relatively avascular portion of the kidney thereby avoiding g any possible damage to the renal vasculature. Often the renal stones are associated with urinary tract infections and coexistence of the two at the same time makes the eradication difficult. It also involves reconstruction of the intrarenal collecting system so as to remove any obstructions present. Hence urinary drainage is improved significantly. This is an open surgical technique and the morbidity rate is also quite high, but it is still the most successful treatment for large and complex renal calculi.
After giving general anesthetics, the patient is placed in a standard flank position so that the position of the kidney is elevated. Adhesive tapes are used to fasten the patient securely to the operating table and pressure padding to protect the pressure points is also placed. The incision is place normally near the 12th rib which depends on the position of the kidney as estimated by the surgeon. The kidney is made fully mobilized; the perinephric fat is completely dissected from it. The kidney is suspended in the operative field and a radiograph is taken to locate the stone .The main renal artery is also dissected. The renal calculi is extracted and removed without any fragmentation. The arteries are then reconnected. A urethral stent is placed during the procedure to prevent the migration of stones during the process. This ensures proper drainage and protects newly reconstructed system. The internal coexistent anatomic abnormalities are then corrected and the entire system is redesigned and reconstructed through calicoplasty. The wounds are then sutured.
After the surgery, tests are conducted to assess the success rate of the surgery. The patient can leave the hospital after 2-3 days. All kinds of physical stain are to be avoided and the stent is left in place till the wounds are fully healed. Post operative complications mostly include bleeding and infection which can be prevented d by taking proper care. Although the surgery is the last choice, this is the most successful one in ensuring removal of stones completely.