Lateral percutaneous nephrolithotomy: A safe and effective surgical approach

Abstract

Introduction:Percutaneous nephrolithotomy (PCNL) is traditionally performed with the patient in the prone position for large renal calculi. However, anesthetic limitations exist with the prone position. Similarly, the supine position is associated with poorer ergonomics due to the awkward downward position of the renal tract, a smaller window for percutaneous puncture, and a higher risk of anterior calyx puncture. This study aimed to demonstrate the feasibility and safety of lateral-PCNL in managing large renal calculi without the disadvantages of prone and supine positions.Methods:Retrospectively, 347 lateral-PCNL cases performed from July 2001 to July 2015 were examined. the patient's thorax, abdomen, and pelvis were positioned over a bridge perpendicular to a “broken” table, creating an extended lumbodorsal space. The procedure was evaluated in terms of stone clearance at 3 months’ postprocedure, operative time, and complications.Results:Primary stone clearance was achieved in 82.7% of patients. The mean operating time was 97 min. The average time taken to establish the tract and mean radiation time were 4.5 min and 6.93 min, respectively. In total, 2.3% of patients required postoperative transfusion, and 13.5% of patients had postoperative fever. There was one case of hydrothorax, but no bowel perforation.Conclusions:Our lateral-PCNL technique allows for effective stone clearance due to good stone ergonomics and it should be considered as a safe alternative even in the most routine procedures.

Consultation on kidney stones, Copenhagen 2019: lithotripsy in percutaneous nephrolithotomy

“…Despite the plausibly lower intrarenal pressure in supine PCNL, it is possible that fragments can descend into the ureter more easily than in the prone position due to gravitational effects. However, in endoscopic combined intrarenal surgery (ECIRS) this is not a problem, because a flexible ureteroscope is positioned in the ureter, both to occupy that position and to detect fragments that might drain into the ureter [43,44].…”

Author reply: Wei Gan JJ, Lia Gan JJ, Hsien Gan JJ, Lee KT. Lateral percutaneous nephrolithotomy: A safe and effective surgical approach. Indian J Urol 2018;34:45-50

“…We thank the readers for their comments to our article. [ 1 ] We fully agree that the optimal access for pelvic/lower pole/upper ureteric stones (in fact, in a majority of large renal stones) is through an upper pole puncture, preferably using the safer subcostal approach. However, this approach can be difficult to achieve in prone/supine percutaneous nephrolithotomy (PCNL) due to inherent anatomical limitations.…”

A new percutaneous nephrolithotomy position in horseshoe kidney: 45 degree sided prone

“…An ideal patient position would provide good anesthetic conditions and ergonomics with minimal intraoperative complications [ 13 ]. In HK, the needle access is generally made to the upper posterior calyces because of the rotation of the kidney.…”