Surgery for stones in the ureters or kidneys was frequently performed with a large incision in the skin some 40 years ago, before the invention of ureteroscopy and Extracorporeal Shockwave Lithotripsy (ESWL). Now open stone surgery is extremely rare as nearly all stones can be treated with less invasive techniques.
Very rarely, it is not possible to gain access to a stone with ureteroscopy or PCNL and the stone cannot be fragmented with ESWL. In this circumstance, surgery can be performed with either a large skin incision or a few smaller incisions using laparoscopy. This is necessary in less than 1 in 1000 cases.
Some patients who require laparoscopic kidney surgery to repair a blockage in the system between the kidney and ureter, can also have their kidney stones removed with the laparoscopic instruments.
Open and laparoscopic surgery are more invasive and are therefore associated with longer lengths of stay in hospital. There is a higher risk of all complications including bleeding, infection and wound hernia, and therefore, this type of operation would only be considered if all other options have been exhausted.