The Barts ‘Flank-Free’ Modified Supine Position for Percutaneous Nephrolithotomy

Abstract

Background: The last decade has seen the emergence of a variety of supine positions for carrying out percutaneous nephrolithotomy (PCNL). These positions all differ with regard to ease of puncture under image guidance, operative field availability, ability to make and dilate multiple tracts and ease of combining retrograde intrarenal surgery (RIRS). As all of these positions have their limitations regarding the important parameters mentioned above, there is a need for a supine position which addresses some of the difficulties. Methods: We describe and illustrate our flank-free modified supine position, which we believe addresses a number of the issues. Results: Our position allows easy percutaneous access under fluoroscopy (torso only tilted to around 15°), space for placing (flank free of support) and dilating multiple tracts (kidney lies in a fairly neutral position and hence less mobile), a fairly horizontal tract allowing low intrarenal pressures and easy washout of fragments as well as allowing RIRS in a position of relative familiarity. The lesser torso rotation compared with the Valdivia, Galdakao modified and the Barts modified Valdivia positions also means it is more comfortable for patients. Conclusions: Our results are encouraging and easily comparable with published series on prone position, Valdivia, complete supine and the Barts modified Valdivia positions. We would like to highlight the Barts ‘flank-free’ modified supine position as one of the standard positions for carrying out supine PCNL.

Application of a Self-Made Equipment for Patient Positioning during Percutaneous Nephroscopy in the Oblique-Supine Position

“…Lower airway pressure and intrapelvic pressure observed with the oblique-supine position suggest possible advantages in safety. The results of the present study are similar to those of previous studies of oblique-supine PCNL [3,[17][18][19][20][21].…”

“…The oblique-supine position for PCNL has advantages over the prone position [3,[17][18][19][20][21], but the current position fixation methods are inadequate [17,22,23]. Therefore, the aim of the present study was to analyze the PNCL outcomes using a patented self-made frame for obliquesupine position.…”

“…In this regards, many authors have tried to modify the surgical position for PCNL. In 1998, Valdivia Uria et al [16] proposed the oblique-supine position, which effectively overcame the disadvantages of the prone position, that is, decreased the rate of intraoperative colonic injury, no chest compression, higher degree of comfort, and avoiding troubles of the intraoperative position switch [3,[17][18][19][20][21].…”

Supine Lithotomy versus Prone Position in Minimally Invasive Percutaneous Nephrolithotomy for Upper Urinary Tract Calculi

“…To overcome these drawbacks, PCNL in the supine position has also been described [5]. Moreover, the supine position has been developed to be a more familiar approach for simultaneous combined PCNL and retrograde ureterorenoscopy (URS) for management of complex stone disease [6,7,8,9]. Additionally, some groups have developed the minimally invasive percutaneous nephrolithotomy (MPCNL) technique, i.e.…”

Prone split-leg position to manage encrusted ureteral stents in a single-stage procedure in women: Step-by-step surgical technique

“…[12][13][14][15][16][17][18][19][20] Although there are no formal guidelines in the management of encrusted double-J stents, 15 several authors have reported their series and proposed algorithms: some with multiple sequential surgical techniques; 15,[19][20][21][22][23] others with a one-step approach. 18,24 Even in this single approach technique, after cystolithopaxy or URS in lithotomy position, the patient must be turned prone for PCNL.…”