En bloc removal of a giant renal calculus in a single sitting via transperitoneal laparoscopic pyelolithotomy: a safe and effective minimally invasive alternative.

Percutaneous nephrolithotomy remains the standard treatment for renal calculi larger than 2 cm; however, giant renal pelvic stones are often associated with the need for multiple tracts or staged procedures and carry risks of bleeding, sepsis, and residual fragments. We report the case of a 60-year-old man who presented with chronic left flank pain and burning micturition. Imaging demonstrated preserved renal function with a 5.2-cm solitary left renal pelvic calculus. The patient underwent transperitoneal laparoscopic pyelolithotomy using a 3-port approach, which enabled complete en bloc stone extraction without fragmentation. A double-J stent was placed and the pyelotomy was closed primarily. The postoperative course was uneventful, with complete stone clearance and resolution of symptoms. This case highlights that laparoscopic pyelolithotomy is a safe, feasible, and effective minimally invasive alternative in selected patients with giant solitary renal pelvic stones, providing excellent single-stage stone clearance with minimal morbidity.