Mp38-18 Prospective Evaluation of the Safety and Efficacy of Spinal Anesthesia vs. General Anesthesia for Percutaneous Nephrolithotomy (Pcnl)

Abstract

URS, with the drawback of longer operating time and low stone free rates with a single procedure in large renal calculi.We propose the use of Laparoassisted PNL (L-PNL) for complex renal stones of >2cm without an access to the kidney free of interpositioned organs.METHODS: We performed 15 L-PNL procedures in our centre in 3 years (2011)(2012)(2013)(2014). All patients were assessed previously by a CT scan in prone and lateral position, who showed the percutaneous path occupied by other abdominal organs (liver-colon in 6 cases, and spleencolon in 9). The medium stone size was 7.32 cm 2 .The technique starts in supine position, with ureteral catheterisation and pyelography to opacify the collect system. In lateral position, transperitoneal laparoscopic access with 5mm ports is performed to mobilize the "problem-organ". This also gives the advantage to control under direct vision all PNL's procedure. The puncture of the elected calix is made by the urologist in the same position, under C-arm fluoroscopic guidance. The energy used to break the stone is lithoclast or lithomaster, and a nitinol basket and tweezers are used to remove the fragments. At the end of the procedure, we leave a simple ureteral stent, removed during the following 24h, and a nephrostomy tube as drainage in all the accesses until its outflow is low. RESULTS: The medium operating time was 112.3min and the average descent of haemoglobin was 1.91mg/dL. The medium hospitalization was 5.6 days (range 3-11)We had no complications related to laparoscopic access. We observed 4 complications related to PNL's procedure that needed a placing of double J stent (1 urinary sepsis due to a small residual stone with ureteral obstruction and 3 urinary fistula due to mucosal oedema or blood clots, without ureteral residual calculi in the CT).12 patients were stone-free at 3 months, evaluated by simple X-ray, ultrasound or CT. 3 patient needed ESWL of small residual renal calculi.CONCLUSIONS: We believe that L-PNL gives us the possibility to perform percutaneous procedures of complex renal stones in patients without good access to the kidney, avoiding the morbidity of open surgery and with a high percentage of success in a single session compared to flexible URS.