Re: Laparoscopic Anatrophic Nephrolithotomy for Management of Complete Staghorn Renal Stone: Clinical Efficacy and Intermediate-Term Functional Outcome (From: Alireza Aminsharifi,Patris Hadian,and Kamran Bovei J Endourol 2013;27:000–000)

Dear Editor:

W e congratulate the authors for demonstrating the technically challenging steps of laparoscopic anatrophic nephrolithotomy, with decreased renal ischemia and reduced morbidity, and assessing its efficacy and feasibility.

There are a few questions that are unanswered in the manuscript. First, the authors' mention that any stenotic infundibulae were opened before the stone was extracted to prevent fracture of the calculus, but they did not perform calicoplasty or caliorrhaphy. Second, in the open technique, ¹ the renal pelvis is closed with a running 5-0 absorbable suture, which was not done by the authors. Was it avoided to minimize renal ischemia time?

Third, the authors' mention that the nephrotomy incision was performed along the Brodel line, but the literature ² suggests a longitudinal nephrotomy 1 to 2 cm posterior to the Brodel white line. Fourth, the nephrotomy incision should not be extended into renal poles ¹ supplied by anterior branches of the renal artery, which are end arteries, ³ but this care probably was not taken (as shown in Fig. 3). Last, a brief about postoperative complications is needed to compare the results with percutaneous nephrolithotomy. It is also difficult to determine the complexity of the cases undertaken, because there were no images of the stones and collecting system anatomy provided in the article. A few intraoperative photos would also have been useful.