With the recent development of technique in laparoscopic surgery, laparoscopic pyelolithotomy (LPL) has been frequently considered as an alternative procedure in the management of large or complex renal stones to percutaneous nephrolithotomy or open surgery. We are presenting a case of complex renal stone burden that was managed laparoscopically. Presentation: A 38-year-old female with numerous large renal stones in the left renal pelvis and in the left kidney on CT scan. She had a history of recurrent pyelonephritis. She had multiple previous renal procedures including failed extracorporeal shock wave Lithotripsy. The patient opted for laparoscopic pyelolithotomy as the next treatment of choice to remove the severe stone burden. A double-J stent was inserted. Procedure: The patient was placed in lithotomy position. Using 4 laparoscopic trocars technique, the renal pelvis was dissected. A longitudinal pyelolithotomy was performed and 16 stones within the renal pelvis were removed intact using the stone forceps. In addition, 3 stones were retrieved from renal calyces. A 3-0-polyglactin suture was used to close the pyelolithotomy running watertight fashion. A suction drain was passed in the peripelvic area. The patient tolerated the procedure well with minimal blood loss. The operative time was145 minutes. Postoperatively the patient did well and went home on postoperative day number 3. ConclusionIn experienced hands laparoscopic pyelolithotomy is safe and feasible. It should be included in the armamentarium of management of patients with large renal pelvis stone load.