The open approach for stone surgery is currently used infrequently in patients undergoing stone removal. Currently an associated anatomic abnormality, a failure of or a contraindication to minimally invasive therapy, or a large and complex stone are the infrequent indications for open surgery. For these indications, laparoscopic or robotic approaches have almost completely replaced open procedures in the hands of skilled laparoscopic surgeons. Pyelolithotomy was supplanted almost 20 years ago by the advent of percutaneous and shock wave technology. Currently, the only indications for this procedure are a failure of or contraindication to other techniques, or the presence of an associated abnormality such as ureteropelvic junction obstruction, which could then be managed simultaneously.
