Percutaneous nephrolithotomy in complete supine flank-free position in comparison to prone position: A single-centre experience

Abstract

ObjectivesTo assess the outcomes of performing percutaneous nephrolithotomy (PCNL) in a modified supine position, more feasible for surgeons, anaesthetists, and operating theatre staff, as well as for the patient himself, and evaluating it in comparison to the standard prone position.Patient and methodsA retrospective, case-control study was conducted between January 2011 and December 2015. In all, 197 patient’s records were reviewed. The initial 101 patients were operated upon in prone position. From mid-2013, 96 patients were operated upon in a complete supine, flank-free position. The groups were compared in terms of operation time, calculated from positioning the patient after anaesthesia induction, insertion of ureteric catheter, puncture of renal system, until the end of procedure; stone-free rate; hospital stay; and postoperative complications, such as transfusion rate, fever, and urinary leakage.ResultsThere were two significant differences between the groups. Firstly, the operation time was a mean (SD) 32.3 (6.6) min shorter for the supine versus the prone position (P < 0.001). Secondly, hospital stay was a mean (SD) 1.2 (0.75) days shorter for the supine vs the prone position (P < 0.001). The complete stone clearance rate (85.4% for supine vs 79.2% for prone; P = 0.2) and postoperative complications (7.3% for supine vs 17.8% for prone; P = 0.02) were comparable in both groups.ConclusionSupine PCNL is a feasible procedure with similar outcomes in terms of stone-free rate as well as postoperative complications, to the standard prone PCNL. It reduces unnecessary delay that occurs during change of position resulting in significant shortening of the total operation time and surgeons can perform supine PCNL whilst sitting.

Comparison of the Efficacy and Safety of the Supine and Prone Positions in Percutaneous Nephrolithotomies for Kidney Stones

“…Based on the stone locations, more than half of the subjects in both groups were diagnosed with staghorn calculi. This finding was different from previous studies stating that staghorn calculi were not commonly found [10,11]. However, this does explain the relatively low stone-free rate in this study.…”

“…Contrary to the results of previous studies, there were no significant outcome differences between the supine and prone groups. In terms of the operative time and stone-free rate, Jones et al [10] and Sohail et al [11] found that the supine position was superior to the prone position. However, it is worth noting that in both studies the staghorn calculi prevalence was less than 50%.…”

The Outcome of supine versus prone percutaneous nephrolithotomy in multiple renal stones Author: - Emad Abdellah. prof Dr Abd Elmoneim Abou zeid. prof Dr Ahmed Hammadi. Assit prof Hazem Elmoghazy

“…arteriovenous fistula, pneumothorax adjacent, visceral injury, or death in either sector. There was no statistically significant difference and this was in agreement with our study (17). Wang et al found that the operation period was much shorter in the prone than in the modified supine posture sector.…”

Supine PCNL is the Way Forward, with Reduced Anesthesia and Operative Times As Compared to Prone PCNL, Along with Comparable Blood Loss and Stone Free Rates

“…Therefore, a sample size of 100 was taken consisting of 50 patients as group A and 50 as group B. This was also comparable to the sample size calculated by OpenEpi™ sample size calculator by obtaining means and standard deviations of a similar study performed (12).…”

“…These adverse effects included changing of patient position causing unnecessary delay, risk of damage to patient's neck, limbs, nerves and eyes; not to forget the least favorable position in morbidly obese patients and those with compromised cardiopulmonary system (2). These outcomes resulted in experimentation of PCNL procedure and thus, supine PCNL was invented by Another retrospective study by Sohail et al (12) conducted from January 2011 to December 2015 on 197 patients showed that the mean operative time in supine PCNL was 32.3+6.6 min shorter than that in the prone position (p<0.001). They also noted that the mean hospital stay was 1.2+0.75 days shorter for the supine vs the prone position (p<0.001).…”