Laparoscopic nephrolithotomy was used as an alternative to open surger
y in a patient who had failed extracorporeal shock-wave lithotripsy an
d whose anteriorly located stone-bearing calix precluded percutaneous
extraction. Endocavitary ultrasonography and color Doppler render the
procedure safe and effective; localization of the stone, selection of
an optimal nephrotomy site away from large vessels and where cortical
thickness is minimal, and control of fragment clearance are greatly fa
cilitated.